Current Treatment Options in Pediatrics

, Volume 4, Issue 1, pp 24–36 | Cite as

Sacral Neuromodulation: Improving Bladder and Bowel Dysfunction in Children

  • Kristin M. Ebert
  • Seth A. Alpert
Urology (P Reddy and B Vanderbrink, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Urology


Purpose of review

Sacral neuromodulation (SNM) is a Food and Drug Administration-approved treatment for bowel and bladder dysfunction in adults, but use in the pediatric population remains an “off-label” indication. We aim to summarize the indications for and clinical outcomes of SNM in children.

Recent findings

A PUBMED® and MEDLINE® search was conducted for articles involving pediatric patients using the keywords “sacral neuromodulation” and “sacral nerve stimulation.” We identified 14 articles; all were reviewed and the results included in this article. Refractory bowel and bladder dysfunction (BBD) was the most common indication for SNM. The S3 nerve root is the most common anatomical location for lead placement. There were no standardized methods of reporting success in the literature. In general, approximately 60–90% of patients had improvement in symptoms, and there were significant decreases in the number of bladder and bowel-related medications used with SNM therapy. Significant improvements in quality of life (QOL) were also reported. The most important reported complication was reoperation, the frequency of which tended to increase with longer duration of therapy.


SNM is an effective therapy for refractory BBD in the carefully selected child. Patients and families should be counseled regarding the risk of reoperation, which tends to increase with time.


Sacral neuromodulation Sacral nerve stimulation Bowel and bladder dysfunction 


Compliance with Ethical Standards

Conflict of Interest

Kristin M. Ebert declares that she has no conflict of interest. Seth A. Alpert declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Leng WW, Chancellor MB. How sacral nerve stimulation neuromodulation works. Urol Clin N Am. 2005 Feb;32(1):11–8. Scholar
  2. 2.
    Guys JM, Haddad M, Planche D, Torre M, Louis-Borrione C, Breaud J. Sacral neuromodulation for neurogenic bladder dysfunction in children. J Urol. 2004;172(4 Pt 2):1673–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Humphreys MR, Vandersteen DR, Slezak JM, Hollatz P, Smith CA, Smith JE, et al. Preliminary results of sacral neuromodulation in 23 children. J Urol. 2006;176(5):2227–31. Scholar
  4. 4.
    Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE. Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J Urol. 2008;180(1):306–11; discussion 311. Scholar
  5. 5.
    Haddad M, Besson R, Aubert D, Ravasse P, Lemelle J, El Ghoneimi A, et al. Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study. J Urol. 2010;184(2):696–701. Scholar
  6. 6.
    van Wunnik BP, Peeters B, Govaert B, Nieman FH, Benninga MA, Baeten CG. Sacral neuromodulation therapy: a promising treatment for adolescents with refractory functional constipation. Dis Colon rectum. 2012;55(3):278–85. Scholar
  7. 7.
    Groen LA, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Ann R, et al. Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience. J Urol. 2012;188(4):1313–7. Scholar
  8. 8.
    Stephany HA, Juliano TM, Clayton DB, Tanaka ST, Thomas JC, Adams MC, et al. Prospective evaluation of sacral nerve modulation in children with validated questionnaires. J Urol. 2013;190(4 Suppl):1516–22. Scholar
  9. 9.
    •• Dwyer ME, Vandersteen DR, Hollatz P, Reinberg YE. Sacral neuromodulation for the dysfunctional elimination syndrome: a 10-year single-center experience with 105 consecutive children. Urology. 2014;84(4):911–7. The largest study with long-term follow up of sacral neuromodulation as a treatment for pediatric bladder dysfunction.CrossRefPubMedGoogle Scholar
  10. 10.
    Sulkowski JP, Nacion KM, Deans KJ, Minneci PC, Levitt MA, Mousa HM, et al. Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children. J Pediatr Surg. 2015;50(10):1644–7. Scholar
  11. 11.
    • Schober MS, Sulkowski JP, Lu PL, Minneci PC, Deans KJ, Teich S, et al. Sacral nerve stimulation for pediatric lower urinary tract dysfunction: development of a standardized pathway with objective urodynamic outcomes. J Urol. 2015;194(6):1721–6. Proposes a treatment protocol for the use of SNM for pediatric refractory BBD.CrossRefPubMedGoogle Scholar
  12. 12.
    • Mason MD, Stephany HA, Casella DP, Clayton DB, Tanaka ST, Thomas JC, et al. Prospective evaluation of sacral neuromodulation in children: outcomes and urodynamic predictors of success. J Urol. 2016;195(4 Pt 2):1239–44. Evaluates preoperative urodynamics and BMI as factors predicting success and complications with SNM.CrossRefPubMedGoogle Scholar
  13. 13.
    van der Wilt AA, van Wunnik BP, Sturkenboom R, Han-Geurts IJ, Melenhorst J, Benninga MA, et al. Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment. Int J Color Dis. 2016;31(8):1459–66. Scholar
  14. 14.
    Lu PL, Asti L, Lodwick DL, Nacion KM, Deans KJ, Minneci PC, et al. Sacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation. J Pediatr Surg. 2017;52(4):558–62. Scholar
  15. 15.
    • Fuchs ME, Lu PL, Vyrostek SJ, Teich S, Alpert SA. Factors predicting complications after sacral neuromodulation in children. Urology. 2017;107:214–7. Evaluates risk factors for complications with pediatric SNM, including BMI.CrossRefPubMedGoogle Scholar
  16. 16.
    Rawashdeh YF, Austin P, Siggaard C, Bauer SB, Franco I, de Jong TP, et al. International Children’s Continence Society’s recommendations for therapeutic intervention in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn. 2012;31(5):615–20. Scholar
  17. 17.
    Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn. 2016;35(4):471–81. Scholar
  18. 18.
    Bartley J, Gilleran J, Peters K. Neuromodulation for overactive bladder. Nat Rev Urol. 2013 Sep;10(9):513–21. Scholar
  19. 19.
    Afshar K, Mirbagheri A, Scott H, MacNeily AE. Development of a symptom score for dysfunctional elimination syndrome. J Urol. 2009;182(4 Suppl):1939–43. Scholar
  20. 20.
    Clark C, Ngo T, Comiter CV, Anderson R, Kennedy W. Sacral nerve stimulator revision due to somatic growth. J Urol. 2011 Oct;186(4 Suppl):1576–80.CrossRefPubMedGoogle Scholar
  21. 21.
    Schober MS, Ching CB, Peters KM, Alpert SA. Novel use of pudendal neuromodulation in a pediatric patient with caudal regression and partial sacral agenesis for refractory bowel bladder dysfunction. Urology. 2016;94:224–6. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Section of UrologyNationwide Children’s HospitalColumbusUSA

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