Intravesical electrostimulation in pediatric patients with spinal cord defects

Creating a low pressure continent urinary storage mechanism for the pediatric patient with neurogenic bladder is difficult. Current therapy, which is enterocystoplasty with intermittent catheterization, is not an ideal solution. In an effort to optimize storage we used intravesical electrostimulation in patients with spinal cord defects.

A retrospective review of all pediatric patients undergoing bladder stimulation was performed. Parameters reviewed included indication, patient age, initial age adjusted pressure specific bladder volume (less than 30 cm. H2O), initial leak point pressure, number of treatments, number of sessions per treatment, posttreatment age adjusted pressure specific bladder volume, voiding and continence status.

Records of all 44 patients treated were reviewed. Indications for treatment included decreasing bladder storage pressures in 24 cases, increased continence between catheterization in 13 and achieving volitional voiding in 7. Patients who became continent had similar age at initiation of treatment, number of treatments, number of sessions, initial leak point pressure and final age adjusted pressure specific bladder volume compared to nonresponders. Nonresponders required surgical intervention to achieve continence with safe storage pressures. Overall, 16% (7 of 44) of patients were continent with safe storage pressures at the completion of treatment and 9% (4 of 44) achieved pretreatment goals.

While some high risk patients were spared surgery due to intravesical electrostimulation, most were not. Spontaneous voiding to completion at safe pressures was not achieved. We were unable to clarify before treatment which patients would benefit from intravesical electrostimulation.