Sacral neuromodulation in pediatric refractory bladder and bowel dysfunction

Insights from Canada’s first pediatric cohort

Authors

  • Roseanne Ferreira University of Toronto
  • Dean Elterman University of Toronto
  • Mandy Rickard Hospital for Sick Children, Toronto
  • Max Freeman Hospital for Sick Children, Toronto
  • Natasha Brownrig Hospital for Sick Children, Toronto
  • Abby Varghese Hospital for Sick Children, Toronto
  • Michael Chua Hospital for Sick Children, Toronto
  • Armando Lorenzo Hospital for Sick Children, Toronto
  • Joana Dos Santos Hospital for Sick Children, Toronto

DOI:

https://doi.org/10.5489/cuaj.8881

Keywords:

SNM, SNS, BBD, Children, Neuromodulation, Canada

Abstract

INTRODUCTION: Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM) as a therapeutic option for children with refractory BBD.

METHODS: Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires.

RESULTS: Six patients completed staged implantation at a median age of 10.8 years (range 8.2–18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10–22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0–7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1–49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0–63.6) at six months.

CONCLUSIONS: SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment’s potential, which must be balanced against the high need for revision detected at three years, possibly related to patients’ growth and high activity level.

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Published

2024-07-23

How to Cite

Ferreira, R. ., Elterman, D. ., Rickard, M. ., Freeman, M. ., Brownrig, N. ., Varghese, A. ., … Dos Santos, J. (2024). Sacral neuromodulation in pediatric refractory bladder and bowel dysfunction: Insights from Canada’s first pediatric cohort. Canadian Urological Association Journal, 18(8), 239–44. https://doi.org/10.5489/cuaj.8881

Issue

Vol. 18 No. 8 (2024): CUAJ August

Section

Original Research

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