We propose that SNS is a valid adjunctive therapy to treat refractory pediatric lower urinary tract symptoms (LUTS) and that prospective collection of pre- and post-operative validated questionnaire and urodynamic data in a standardized fashion is beneficial in characterizing patient response to SNS therapy.
Patients were candidates for sacral nerve stimulation if they had refractory voiding dysfunction and had failed standard treatments. Preoperative evaluation included urodynamic studies, spinal magnetic resonance imaging, and validated bladder and bowel related questionnaires. Children were stratified into 2 groups, ie overactive bladder with or without incontinence (group 1) and detrusor underactivity/urinary retention requiring clean intermittent catheterization (group 2). A staged procedure was used with initial test lead placement, followed by permanent device insertion 2 weeks later if patients demonstrated symptom improvement with test lead. Postoperatively children were followed with questionnaires and at least 1 urodynamic study.
A total of 26 children underwent sacral nerve stimulation. Mean patient age was 10.8 years and median followup was 1.2 years. There were 23 patients in group 1 and 4 in group 2 (1 patient was included in both groups). In group 1 voiding dysfunction scores improved significantly, and urodynamic studies revealed a significant decrease in mean number of uninhibited contractions and maximum detrusor pressure during the filling phase. In group 2 there was significant improvement in mean post-void residual.
SNS is a treatment option that may produce significant improvement in both objective and subjective measures of bladder function in refractory pediatric LUTS.
The Journal of urology 2015 Jun 30 [Epub ahead of print]
Megan S Schober, Jason P Sulkowski, Peter L Lu, Peter C Minneci, Katherine J Deans, Steven Teich, Seth A Alpert
Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio , Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio , Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio , Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio , Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio , Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio , Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio