SUFU WM 2015 - Neuromodulation in children - Session Highlights

SCOTTSDALE, AZ USA (UroToday.com) - There were several presentations on neuromodulation, which included pudendal and sacral stimulation. One presentation of particular interest was by Dr. Yuri Reinberg from Children’s Hospital in Minnesota who presented data on pediatric sacral neurostimulation (SNS). Dr. Reinberg noted that bladder and bowel dysfunction (BBD) in children is primarily treated with interventions such as behavioral (timed voiding, dietary modifications, biofeedback), drug therapy, and intermittent catheterization. But these treatments are not always successful, and in the last 10 years Dr Reinberg has been offering InterStim® to children with recalcitrant BBD.

sufuHe presented the accumulated data on improvement or resolution of symptoms and complications on 150 consecutive children. Outcome criteria were symptom improvement of ≥ 50% reduction of symptom(s) or symptoms resolution (defined as no symptoms present at last follow-up). Data from 133 children (female-105; male-28) were analyzed and 131 had full device implanted, 2 children did not have an IPG inserted because of poor response during stage one. Median age at device implantation was 9 years. Children initially underwent two-stage (n=98) and procedure was recently changed to one-stage (n=33).

Results were as follow:

  • Incontinence (n=127). Improved 67 (53%); resolved 43 (34%)
  • Urgency/frequency (n=83). Improved 15 (18%); resolved 24 (29%)
  • Nocturia (n=107). Improved 11 (10%); resolved 28 (26%)
  • Constipation (n=109) resolved 42 (39%)

But these were not statistically significant differences.

Device revision was required in 41 (31%) children, of which the causes of 48% (n=22) of the revisions were unknown. Since 2009, this group has offered both two-stage and single-stage approaches and comparison data were presented. There appeared to be little difference in symptom improvement and no increase in device related infections, but anesthesia time was less with one-stage approach. This group has treated children with SNS who have co-existing BBD and attention deficit and hyperactivity disorder (ADHD (n=29) who had become refractory to maximum medical and behavioral therapy. There were no symptom differences seen in children with or without ADHD who received SNS, but outcomes did not reach significance. A limitation of this work is that although the study may cover a 10-year period, half of the patients underwent initial procedure within the last 3 years and long-term follow-up is lacking. Also, it is not clear if PTNS was a treatment offered in these children.

Presented by Yuri E. Reinberg, MD at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA

Children’s Hospital and Clinics, Minneapolis, MN USA

Reported by Diane K. Newman, DNP, FAAN, BCB-PMD, medical writer for UroToday.com