Pediatric Sacral Neuromodulation for Voiding Dysfunction
Electrical stimulation of the lower urinary tract is a well established treatment for several etiologies of voiding dysfunction in adults, but its use in children is relatively novel. Voiding dysfunction accounts for roughly 30% of visits to a pediatric urologist (Rushton, Urol Clin North Am 22:75, 1995). The constellation of symptoms can be especially frustrating to the child, parents and physician given the frequent visits and numerous therapies. First line therapy is typically limited to behavioral modifications including timed voiding, adjustments to fluid intake, dietary modifications and treatment of bowel dysfunction. Additional treatment options include: biofeedback, anti-cholinergic and alpha-adrenergic medications, intravesical botulinum toxin injection and clean intermittent catheterization. In appropriately selected patients, sacral neuromodulation (SNM) can be used to treat children with medically refractory voiding dysfunction.
KeywordsNeuromodulation Bowel-bladder dysfunction Urodynamic study