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Pediatric Overactive Bladder and the Role of Sacral Neuromodulation

  • Pediatric Urology (BA VanderBrink and RP Pramod, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of Review

Overactive bladder is the most common cause of voiding dysfunction in the pediatric population. Bladder overactivity can be challenging to address often requiring “trial and error” and a multimodal treatment plan. The purpose of this manuscript is to summarize the role and efficacy of sacral neuromodulation in the treatment of pediatric bladder overactivity.

Recent Findings

The exact mechanism of action of sacral neuromodulation is poorly understood. Sacral neuromodulation likely has a multifactorial effect on the voiding pathway acting on both the peripheral and central nervous system per functional MRI studies. Modulation of a child’s developing neural pathways has shown to have durable effects with improvements persisting after the device has been deactivated and/or explanted.

Summary

Pediatric bladder overactivity should be treated in step-wise fashion, starting with the least invasive therapy. Sacral neuromodulation should be considered only in refractory cases. Sacral neuromodulation is effective in decreasing, and may completely resolve bothersome lower urinary tract symptoms. These improvements in bladder symptoms translate into improvements in a child’s and caregiver’s quality of life. In appropriately selected patients, sacral neuromodulation is a succesful long-term treatment for overactive bladder.

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Abbreviations

OAB:

Overactive bladder

UTI:

Urinary tract infection

QOL:

Quality of life

ICCS:

International Children’s Continence Society

SNM:

Sacral neuromodulation

References and Recommended Reading

  1. Franco I. Overactive bladder in children. Part 1: Pathophysiology. J Urol. 2007;178(3 Pt 1):761-8; discussion 768. https://doi.org/10.1016/j.juro.2007.05.014. Epub 2007 Jul 16.

  2. 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;35:471–81 John Wiley & Sons.

    Article  Google Scholar 

  3. Fitzgerald MP, Thom DH, Wassel-Fyr C, Subak L, Brubaker L, Van Den Eeden SK, et al. Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol. 2006;175:989–93 Wolters KluwerPhiladelphia, PA.

    Article  Google Scholar 

  4. Natale N, Kuhn S, Siemer S, Stöckle M, von Gontard A. Quality of life and self-esteem for children with urinary urge incontinence and voiding postponement. J Urol. 2009;182:692–8.

    Article  CAS  Google Scholar 

  5. van den Heijkant M, Bogaert G. Lower urinary tract terminology in daytime lower urinary tract symptoms in children: a view of the pediatric urologist. Eur Urol Focus. 2017;3:189–97 Elsevier.

    Article  Google Scholar 

  6. Nieuwhof-Leppink AJ, Hussong J, Chase J, Larsson J, Renson C, Hoebeke P, et al. Definitions, indications and practice of urotherapy in children and adolescents: a standardization document of the International Children’s Continence Society (ICCS). J Pediatr Urol. 2021;17:172–81 Elsevier.

    Article  CAS  Google Scholar 

  7. Meijer EFJ, Nieuwhof-Leppink AJ, Dekker-Vasse E, De Joode-Smink GCJ, De Jong TPVM. Central inhibition of refractory overactive bladder complaints, results of an inpatient training program. J Pediatr Urol J Pediatr Urol. 2015;11:21.e1-21.e5.

    Article  CAS  Google Scholar 

  8. Vijverberg MAW, Elzinga-Plomp A, Messer AP, Van Gool JD, De Jong TPVM. Bladder rehabilitation, the effect of a cognitive training programme on urge incontinence. Eur Urol Eur Urol. 1997;31:68–72.

    Article  CAS  Google Scholar 

  9. Jessen AS, Hagstroem S, Borch L. Comparison and characteristics of children successfully treated for daytime urinary incontinence. J Pediatr Urol [Internet]. J Pediatr Urol; 2021 [cited 2022 Feb 12]; Available from: https://pubmed-ncbi-nlm-nih-gov.proxy.ulib.uits.iu.edu/34930690/

  10. Franco I. Overactive bladder in children. Part 2: management. J Urol. 2007;178:769–74.

    Article  Google Scholar 

  11. Keam SJ. Mirabegron: pediatric first approval. Paediatr Drugs [Internet]. Paediatr Drugs; 2021 [cited 2022 Jul 21];23:411–5. Available from: https://pubmed-ncbi-nlm-nih-gov.proxy.ulib.uits.iu.edu/34056686/

  12. Blais AS, Nadeau G, Moore K, Genois L, Bolduc S. Prospective pilot study of mirabegron in pediatric patients with overactive bladder. Eur Urol. 2016;70:9–13 Elsevier.

    Article  Google Scholar 

  13. Arlen AM. Dysfunctional voiders—medication versus urotherapy? Current urology reports. Current Medicine Group LLC. 2017;1(18):1–6.

    Google Scholar 

  14. Hoebeke P, De Caestecker K, Vande Walle J, Dehoorne J, Raes A, Verleyen P, et al. The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor. J Urol. 2006;176:328–31 United States.

    Article  CAS  Google Scholar 

  15. Tanagho EA, Schmidt RA, Orvis BR. Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol. 1989;142:340–5 United States.

    Article  CAS  Google Scholar 

  16. Guys JM, Haddad M, Planche D, Torre M, Louis-Borrione C, Breaud J. Sacral neuromodulation for neurogenic bladder dysfunction in children. J Urol. 2004;172:1673–6 Wolters KluwerPhiladelphia, PA.

    Article  CAS  Google Scholar 

  17. 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;176:2227–31 No longer published by Elsevier.

    Article  Google Scholar 

  18. Gill BC, Pizarro-Berdichevsky J, Bhattacharyya PK, Brink TS, Marks BK, Quirouet A, et al. Real-time changes in brain activity during sacral neuromodulation for overactive bladder. J Urol. 2017;198:1379–85.

    Article  Google Scholar 

  19. Fowler CJ, van Kerrebroeck PE, Nordenbo A, Van Poppel H. Treatment of lower urinary tract dysfunction in patients with multiple sclerosis. Committee of the European Study Group of SUDIMS (sexual and urological disorders in multiple sclerosis). J Neurol Neurosurg Psychiatry. 1992;55:986–9.

    Article  CAS  Google Scholar 

  20. Boswell TC, Hollatz P, Hutcheson JC, Vandersteen DR, Reinberg YE. Device outcomes in pediatric sacral neuromodulation: a single center series of 187 patients. J Pediatr Urol. 2021;17:72.e1-72.e7 Elsevier.

    Article  Google Scholar 

  21. 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;180:306–11.

    Article  Google Scholar 

  22. Groen L-A, 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;188:1313–7 2012/08/16. United States.

    Article  Google Scholar 

  23. 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;184:696–701.

    Article  CAS  Google Scholar 

  24. 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 ®j.juro. 2016;195:1239–44.

    Article  Google Scholar 

  25. 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;190:1516–22.

    Article  Google Scholar 

  26. Rensing AJ, Szymanski KM, Dunn S, King S, Cain MP, Whittam BM. Pediatric sacral nerve stimulator explanation due to complications or cure: a survival analysis. J Pediatr Urol. 2019;15:39.e1-39.e6 Elsevier.

    Article  CAS  Google Scholar 

  27. Chen G, Liao L, Deng H. The effect of sacral neuromodulation in ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction. Urology. 2021;153:345–50 Elsevier.

    Article  Google Scholar 

  28. 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 Journal of Urology 2019 37:12 [Internet]. Springer; 2019 [cited 2022 Jul 21];37:2775–83. Available from: https://link-springer-com.proxy.ulib.uits.iu.edu/article/https://doi.org/10.1007/s00345-019-02721-x

  29. Fuchs ME, Lu PL, Vyrostek SJ, Teich S, Alpert SA. Factors predicting complications after sacral neuromodulation in children. Urology Elsevier. 2017;107:214–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Riley Hospital for Children, Indiana University, 705 Riley Hospital Drive, Suite 4230, IN, 46202, Indianapolis, USA

    Ashley W. Johnston MD & Benjamin M. Whittam MD, MS

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Correspondence to Ashley W. Johnston MD.

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Ashley W. Johnston declares that she has no conflict of interest. Benjamin M. Whittam declares that he has no conflict of interest.

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Johnston, A.W., Whittam, B.M. Pediatric Overactive Bladder and the Role of Sacral Neuromodulation. Curr Treat Options Peds 8, 412–422 (2022). https://doi.org/10.1007/s40746-022-00256-9

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