Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A Single Center Experience With 20 Children

Abstract

Sacral nerve stimulation is effective in the majority of our patients, and should be considered in children with severe dysfunctional elimination syndrome refractory to maximum medical treatment.

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

“…2 Bladder capacity evaluated by 3-day voiding diary and UDS was significantly different between neurogenic and non-neurogenic patients both initially (p < 0.0001) and after (p = 0.033) treatment with anticholinergic combination therapy. 3 Bladder capacity evaluated by UDS was significantly different between neurogenic and nonneurogenic patients both initially (p < 0.0001) and after (p = 0.008) treatment with anticholinergic combination therapy. 4 Amplitude of detrusor contractions on UDS were significantly decreased by combination treatment; overall, neurogenic and non-neurogenic groups (p < 0.0001).…”

“…13 Parents or patients supervised by their parents rated symptom relief efficacy on a questionnaire as complete cure (defined as dryness), improvement (a reduction by at least 90% in incontinence episodes) or partial improvement (a reduction by 50%- If oxybutinin ER was not well tolerated, it was discontinued and changed for Tolterodine ER 4 mg. 2 Suboptimal response: based on clinical and/or urodynamic study criteria. 3 Introduction of the second anticholinergic medication. 4 If tolterodine ER 4 mg was not well tolerated as a second anticholinergic medication, it was discontinued and changed for solifenacin 5 mg. 5 If solifenacin was not well-tolerated, it was discontinued and alternative treatment was offered.…”

“…For patients with intractable symptoms, before considering more invasive strategies, the first step is usually an increased dose of the single anticholinergic, which naturally increases the likelihood of bothersome side effects. Possible subsequent steps include intravesical instillation of oxybutynin, 1,2 sacral neuromodulation, [3][4][5] or intradetrusor injection of botulinum toxin. [6][7][8][9] Most of these methods are still under evaluation in the pediatric population.…”

Non-neuropathic bladder dysfunctions, and treatment approaches

“…Son zamanlarda, implante edilen cihazla yapılan sakral TENS'in ciddi DES olan çocuklar-da çok etkili olduğu gösterilmiştir (54). Bu nedenle, sakral nöromodülasyon ciddi tedaviye yanıtsız olgularda olası bir tedavi alternatif olarak ortaya çık-maktadır.…”

Sacral Neuromodulation in Children

“…Based on our experience and current literature, SNM should only be considered in children who have failed an extended period of behavioral modification, biofeedback, and pharmacologic therapy [9][10][11][12][13][14][15]. Several groups have also offered intravesical botulinum toxin A, transcutaneous electrical nerve stimulation, and percutaneous tibial nerve stimulation to this population of children but have not required them to fail these less invasive therapies prior to SNM [13,15].…”