Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A 10-Year Single-center Experience With 105 Consecutive Children

• Published in: Urology (Ridgewood, N.J.) Vol. 84; no. 4; pp. 911 - 918
• Main Authors: Dwyer, Moira E, Vandersteen, David R, Hollatz, Pam, Reinberg, Yuri E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014
• Subjects: Adolescent; Child; Electric Stimulation Therapy - adverse effects; Electric Stimulation Therapy - methods; Female; Humans; Implantable Neurostimulators; Lumbosacral Plexus; Male; Prospective Studies; Time Factors; Urination Disorders - therapy; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2014.03.059

Objective To evaluate our initial experience using sacral neuromodulation via implanted pulse generator as a treatment for children with dysfunctional elimination syndrome and symptoms refractory to maximum medical therapy. Materials and Methods There were 105 consecutive patients who underwent a 2-stage procedure with a trial period (n = 89) or a single procedure (n = 16) for device implantation. They were followed up prospectively for a median of 2.72 years (average, 3.18 years; range, 0.01-9.63 years) for symptom improvement and resolution. Results Nearly all children (99 of 105 [94%]) experienced improvement of at least 1 symptom; 12 of 105 patients (11%) had at least 1 symptom worsen. Urinary incontinence, constipation, frequency and/or urgency, and nocturnal enuresis improved in 89 of 101 (88%), 73 of 92 (79%), 54 of 81 (67%), and 59 of 89 (66%) children, respectively, and resolved in 41 of 101 (41%), 37 of 92 (40%), 23 of 81 (28%), and 25 of 89 (28%) children, respectively. Outcomes among patients who did and did not undergo the trial were not significantly different ( P  = .19-1.00), and only 2 of 88 patients did not undergo permanent implantation. Reoperations (n = 85) occurred in 59 of 105 children (56%), mainly for device malfunction (n = 42), whereas explantation was performed in 36 of 104 children (35%) at an average of 2.68 years since implantation (median, 2.36 years; range, 0.03-9.04 years), mainly for complete symptom resolution (n = 12). Explantation for any reason was less common after single-stage procedures (1 of 16 [6%] vs 35 of 88 [40%] patients; P  = .01). Conclusion Sacral neuromodulation should be considered for children with dysfunctional elimination syndrome whose symptoms are refractory to maximum medical therapy understanding that the risk of reoperation is >50%. Elimination of the trial period reduces the number of general anesthetics without sacrificing outcomes.