Sacral Neuromodulation in Children
Stimulation of the parasympathetic nerves via the sacral micturition centre travels in the pelvic nerve, resulting in contraction of the detrusor muscle and relaxation of the sphincter facilitating micturition. Different modalities of neuromodulation have been used in children, and the level of interest for treating bladder-bowel dysfunction is high with SNM over time. In adult patients invasive SNM using electrode in third sacral foramina is largely utilized while is limited in paediatrics. Indications still controversial, and the third sacral (S3) nerve root remains the main access point used for neuromodulation. Nowadays this treatment is considered as a second- or third-line treatment for patients when conservative or less-invasive treatment has failed. Moreover some studies in literature have demonstrated their safety and effectiveness in well-selected cases as a reversible and mini-invasive treatment for neurogenic bladder, demonstrating an improvement on urodynamic parameters such us the bladder capacity or bladder compliance after SNM implantation and even an improvement on bowel dysfunction.
KeywordsSacral neuromodulation Neurogenic bladder Neurogenic bowel Nonobstructive urinary retention Children Lower urinary tract dysfunction Urodynamics Bowel bladder dysfunction Constipation Spina bifida
- 4.Herbison GP, Arnold EP. Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane Database Syst Rev. 2009;2:CD004202. PubMed PMID: 19370596Google Scholar
- 6.van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, Lycklama a Nijholt AA, Siegel S, Jonas U, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178(5):2029–34. PubMed PMID: 17869298CrossRefPubMedGoogle Scholar