BERKELEY, CA (UroToday.com) - A study out of the Mayo Clinic by Dr. Timothy Roth, et al. evaluated sacral neuromodulation for dysfunctional elimination syndrome wherein they evaluated the InterStim^® implantable device for the management of chronic urinary complaints in children. The study group was comprised of 20 patients, ranging in age from 8 to 17 years, and with the dysfunctional elimination syndrome refractory to maximum medical therapy. The patients were followed prospectively for a mean of 27 months after their procedures.

The doctors found that urinary incontinence, urgency and frequency, nocturnal enuresis and constipation were improved or resolved in 88%, 69%, 89%, and 69% respectively. In their study , there were 4 patients with urinary retention requiring intermittent catheterization, and only 1 out of 4 exhibited improvement after sacral nerve stimulation. The remaining 3 patients needed to stay on intermittent catheterization. Of the 20 patients, 4 of them had complications requiring operative treatment. These complications included fear of the device itself (requiring explanation) as well as other complications such as beat displacement. Two patients were completely asymptomatic at 20 and 19 months. Both of these patients had their devices explanted and remained symptom free.

The group felt that sacral nerve stimulation was effective in the majority of their patients. Their recommendation was that it should be considered in children with severe dysfunctional elimination syndrome refractory to maximum medical treatment. They also felt the part of the spectrum that made the biggest improvement overall was constipation with encopresis.

Dr. Julian Wan added an editorial comment. He felt that no true conclusions could be drawn from this study since it included only a small number of patients and their symptomatology was so varied. He did acknowledge that the data supported that the device could be deployed safely and with few problems in children, and some of the children did benefit. Nonetheless he felt that these children needed to be characterized and would require further study.

Another editorial comment was made by Andrew J. Combs who pointed out that only 40% of the children who received sacral neuromodulation underwent a formal urodynamic study. He also felt – as did Dr. Wan, that the children had greatly varied and nonspecific overall diagnoses made.

Nonetheless we all know, although rare, that some children do not respond well to any medical management for biofeedback. Some of these children can progress to such a dysfunctional voiding that they can truly decompensate their bladders. It would be important to try to figure out who these children might potentially be so we can intervene earlier. If neuromodulation could save them any morbidity from their dysfunctional voiding as far as bladder decompensation is concerned, then this intervention would not only be warranted but welcomed.

Timothy J. Roth, David R. Vandersteen, Pam Hollatz, Brant A. Inman and Yuri E. Reinberg

J Urol. 2008 Jul;180(1):306-11
10.1016/j.juro.2008.03.033

PubMed Abstract
PMID: 18499169

UroToday.com Pediatric Urology Section

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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