Sacral Neuromodulation: Improving Bladder and Bowel Dysfunction in Children

Abstract

Purpose of review: Sacral neuromodulation (SNM) is a Food and Drug Administration-approved treatment for bowel and bladder dysfunction in adults, but use in the pediatric population remains an "off-label" indication. We aim to summarize the indications for and clinical outcomes of SNM in children. Recent findings: A PUBMED and MEDLINE search was conducted for articles involving pediatric patients using the keywords "sacral neuromodulation" and "sacral nerve stimulation." We identified 14 articles; all were reviewed and the results included in this article. Refractory bowel and bladder dysfunction (BBD) was the most common indication for SNM. The S3 nerve root is the most common anatomical location for lead placement. There were no standardized methods of reporting success in the literature. In general, approximately 60-90% of patients had improvement in symptoms, and there were significant decreases in the number of bladder and bowel-related medications used with SNM therapy. Significant improvements in quality of life (QOL) were also reported. The most important reported complication was reoperation, the frequency of which tended to increase with longer duration of therapy. Summary: SNM is an effective therapy for refractory BBD in the carefully selected child. Patients and families should be counseled regarding the risk of reoperation, which tends to increase with time.Copyright © 2018, Springer International Publishing AG, part of Springer Nature.