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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

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A Letter to the Editor to this article was published on 03 June 2019

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.

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References

  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):1673–1676

    Article  CAS  Google Scholar 

  2. Daneshgari F, Moy ML (2005) Current indications for neuromodulation. Urol Clin North Am 32(1):37–40

    Article  Google Scholar 

  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

    Article  Google Scholar 

  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):696–701

    Article  CAS  Google Scholar 

  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):396–398

    Article  Google Scholar 

  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):612–626

    Article  CAS  Google Scholar 

  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):541–545

    Article  CAS  Google Scholar 

  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):915–928

    Article  Google Scholar 

  9. Joussain C, Denys P (2015) Electrical management of neurogenic lower urinary tract disorders. Ann Phys Rehabil Med 58(4):245–250

    Article  CAS  Google Scholar 

  10. Tanagho EA, Schmidt RA (1982) Bladder pacemaker: scientific basis and clinical future. Urology 20(6):614–619

    Article  CAS  Google Scholar 

  11. Wyndaele JJ, Michielsen D, Van Dromme S (2000) Influence of sacral neuromodulation on electrosensation of the lower urinary tract. J Urol 163(1):221–224

    Article  CAS  Google Scholar 

  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):2323–2326

    Article  CAS  Google Scholar 

  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):2035–2039

    Article  CAS  Google Scholar 

  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):2035–2039

    Article  CAS  Google Scholar 

  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):629–636

    Article  CAS  Google Scholar 

  16. Kessler TM, Wollner J, Kozomara M, Mordasini L, Mehnert U (2012) Sacral neuromodulation for neurogenic bladder dysfunction. Urologe A 51(2):179–183

    Article  CAS  Google Scholar 

  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):1313–1318

    Article  Google Scholar 

  18. Tanagho EA (1992) Neuromodulation in the management of voiding dysfunction in children. J Urol 148(2 Pt 2):655–657

    Article  CAS  Google Scholar 

  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):2227–2231

    Article  Google Scholar 

  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 195:1239–1244

    Article  Google Scholar 

  21. Fuchs ME, Lu PL, Vyrostek SJ, Teich S, Alpert SA (2017) The factors predicting complications after sacral neuromodulation in children. Urology 107:214–217

    Article  Google Scholar 

  22. Scheepens WA, Jongen MM, Nieman FH et al (2002) Predictive factors for sacral neuromodulation in chronic lower urinary tract dysfunction. Urology 60:598

    Article  CAS  Google Scholar 

  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 31:1–6

    Article  Google Scholar 

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Acknowledgement

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

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Authors and Affiliations

  1. Shahid Labbafinejad Medical Center, Urology Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 103, Boostan 9th St, Pasdaran Ave, Tehran, 1666663111, Iran

    Farzaneh Sharifiaghdas

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

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Correspondence to Farzaneh Sharifiaghdas.

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This article does not contain any studies with animals.

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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.

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Sharifiaghdas, F. 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. World J Urol 37, 2775–2783 (2019). https://doi.org/10.1007/s00345-019-02721-x

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  • DOI: https://doi.org/10.1007/s00345-019-02721-x

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