Sacral Neuromodulation for Bladder Dysfunction in Children: Indications, Results and Complications

Abstract

Purpose of review

Sacral neuromodulation (SNM) is an approved treatment in adults. Despite multiple publications about its safety and efficacy in children, SNM has yet to be approved by the Food and Drug Administration for use in this population. We aim to review all the published literature on SNM in children.

Recent findings

A PUBMED® and MEDLINE® search was performed for scientific publications on “sacral neuromodulation” and “sacral nerve stimulation” in pediatric patients. A total of ten unique articles published between 2006 and 2016 were identified. Each of these publications was thoroughly reviewed and the results included in this article. Refractory bowel and bladder dysfunction (BBD) is the primary indication for SNM placement. The S3 nerve root is the most common anatomical location for lead placement and it is most commonly placed in two stages. The first stage is followed by a trial period to assess symptomatic improvement prior to the second stage when the implantable pulse generator is placed. Symptom improvement ranges across studies but generally improvement or resolution is seen in 60–90 % of patients when properly selected. Potential complications include infection, lead breakage or migration, pain at the insertion site, device erosion, and device failure. Such complications are rare and SNM placement is generally accepted as successful and safe.

Summary

Sacral neuromodulation is an effective intervention for refractory bowel and bladder dysfunction in the carefully selected child. This technology is not approved for use in children younger than 16 in the United States, but as the body of literature grows, it is feasible that its application in the pediatric population will become more widely accepted.