Advertisement

World Journal of Urology

, Volume 37, Issue 12, pp 2775–2783 | Cite as

Sacral neuromodulation in congenital lumbo-sacral and traumatic spinal cord defects with neurogenic lower urinary tract symptoms: a single-center experience in children and adolescents

  • Farzaneh SharifiaghdasEmail author
Original Article

Abstract

Purpose

This study evaluated sacral neuromodulation’s effectiveness for managing refractory neuropathic lower urinary tract dysfunction in children and adolescents.

Methods

Twenty-five children and adolescents underwent peripheral nerve evaluation test phase of sacral neuromodulation at our center. Thirteen (seven boys and six girls) cases suffered from neuropathic lower urinary tract dysfunction refractory to the maximum medical treatment. The test was done with temporary wire in all patients. Patients with more than 50% improvement in symptoms were chosen for the second stage of implantation of quadripolar tined lead and implantable pulse generator. Bowel transit symptoms were recorded before and after the surgery.

Results

Eight patients (61.53%; five boys and three girls) had positive responses to the peripheral nerve evaluation test phase. They underwent implantation of permanent quadripolar tined lead and implantable pulse generator. The etiologies were lumbosacral myelomeningocele, occult spina bifida, partial sacral agenesis and incomplete spinal cord injury. Positive clinical response (> 50% improvement in symptoms) was achieved in seven (85%) at a mean follow-up of 14.25 months. Three patients became capable to stop clean intermittent catheterization (P =0.125). The 24-h pad test decreased from 484 to 78 g from before to after the surgery (P =0.043).

Conclusion

This clinical study on a small sample size of children and adolescents demonstrates positive results in short-term follow-up. However, as the procedure is still not approved officially, multicenter studies with more patients can prove the safety and efficacy of sacral neuromodulation in long term among this special group of patients.

Keywords

Child Urinary incontinence Electric stimulation therapy Congenital abnormalities Neuropathic 

Notes

Acknowledgement

The author thanks Muhammed Hussein Mousavinasab for his sincere cooperation in editing this text.

Authors contribution

One author has done the data collection, data analysis and writing of the manuscript.

Compliance with ethical standards

Conflict of Interest

The authors declare that htey have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with animals.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the ethics committee of our university.

Informed consent

Written informed consent was obtained from the patients and their parents.

References

  1. 1.
    Guys JM, Haddad M, Planche D, Torre M, Louis-Borrione C, Breaud J (2004) Sacral neuromodulation for neurogenic bladder dysfunction in children. J Urol 172(4 Pt 2):1673–1676CrossRefGoogle Scholar
  2. 2.
    Daneshgari F, Moy ML (2005) Current indications for neuromodulation. Urol Clin North Am 32(1):37–40CrossRefGoogle Scholar
  3. 3.
    Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE (2008) Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J Urol 180(1):306–311 discussion 11 CrossRefGoogle Scholar
  4. 4.
    Haddad M, Besson R, Aubert D, Ravasse P, Lemelle J, El Ghoneimi A et al (2010) Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study. J Urol 184(2):696–701CrossRefGoogle Scholar
  5. 5.
    Lippmann QK, Geller EJ (2014) Successful use of sacral neuromodulation in a 12-year-old with cerebral palsy and neurogenic bladder. Neuromodulation 17(4):396–398CrossRefGoogle Scholar
  6. 6.
    Baker SS, Liptak GS, Colletti RB, Croffie JM, Di Lorenzo C, Ector W et al (1999) Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 29(5):612–626CrossRefGoogle Scholar
  7. 7.
    Spinelli M, Bertapelle P, Cappellano F, Zanollo A, Carone R, Catanzaro F et al (2001) Chronic sacral neuromodulation in patients with lower urinary tract symptoms: results from a national register. J Urol 166(2):541–545CrossRefGoogle Scholar
  8. 8.
    de Seze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B (2007) The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler 13(7):915–928CrossRefGoogle Scholar
  9. 9.
    Joussain C, Denys P (2015) Electrical management of neurogenic lower urinary tract disorders. Ann Phys Rehabil Med 58(4):245–250CrossRefGoogle Scholar
  10. 10.
    Tanagho EA, Schmidt RA (1982) Bladder pacemaker: scientific basis and clinical future. Urology 20(6):614–619CrossRefGoogle Scholar
  11. 11.
    Wyndaele JJ, Michielsen D, Van Dromme S (2000) Influence of sacral neuromodulation on electrosensation of the lower urinary tract. J Urol 163(1):221–224CrossRefGoogle Scholar
  12. 12.
    Malaguti S, Spinelli M, Giardiello G, Lazzeri M, Van Den Hombergh U (2003) Neurophysiological evidence may predict the outcome of sacral neuromodulation. J Urol 170(6 Pt 1):2323–2326CrossRefGoogle Scholar
  13. 13.
    Hansen J, Media S, Nohr M, Biering-Sorensen F, Sinkjaer T, Rijkhoff NJ (2005) Treatment of neurogenic detrusor overactivity in spinal cord injured patients by conditional electrical stimulation. J Urol 173(6):2035–2039CrossRefGoogle Scholar
  14. 14.
    Hansen J, Media S, Nohr M, Biering-Sorensen F, Sinkjaer T, Rijkhoff NJ (2005) Treatment of neurogenic detrusor overactivity in spinal cord injured patients by conditional electrical stimulation. J Urol 173(6):2035–2039CrossRefGoogle Scholar
  15. 15.
    Lombardi G, Nelli F, Mencarini M, Del Popolo G (2011) Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury. Spinal Cord 49(5):629–636CrossRefGoogle Scholar
  16. 16.
    Kessler TM, Wollner J, Kozomara M, Mordasini L, Mehnert U (2012) Sacral neuromodulation for neurogenic bladder dysfunction. Urologe A 51(2):179–183CrossRefGoogle Scholar
  17. 17.
    Groen L-A, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Ann R et al (2012) Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience. J Urol 188(4):1313–1318CrossRefGoogle Scholar
  18. 18.
    Tanagho EA (1992) Neuromodulation in the management of voiding dysfunction in children. J Urol 148(2 Pt 2):655–657CrossRefGoogle Scholar
  19. 19.
    Humphreys MR, Vandersteen DR, Slezak JM, Hollatz P, Smith CA, Smith JE et al (2006) Preliminary results of sacral neuromodulation in 23 children. J Urol 176(5):2227–2231CrossRefGoogle Scholar
  20. 20.
    Mason MD, Stephany HA, Casella DP, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC (2016) Prospective evaluation of sacral neuromodulation in children: outcomes and urodynamic predictors of success. J Urol 195:1239–1244CrossRefGoogle Scholar
  21. 21.
    Fuchs ME, Lu PL, Vyrostek SJ, Teich S, Alpert SA (2017) The factors predicting complications after sacral neuromodulation in children. Urology 107:214–217CrossRefGoogle Scholar
  22. 22.
    Scheepens WA, Jongen MM, Nieman FH et al (2002) Predictive factors for sacral neuromodulation in chronic lower urinary tract dysfunction. Urology 60:598CrossRefGoogle Scholar
  23. 23.
    Rawashdeh YF, Austin P, Siggaard C, Bauer SB, Franco I, de Jong TP, Jorgensen TM (2012) International children`s continence society`s recommendations for therapeutic intervention in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn 31:1–6CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Shahid Labbafinejad Medical Center, Urology Nephrology Research CenterShahid Beheshti University of Medical SciencesTehranIran

Personalised recommendations