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Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children
Jason P Sulkowski1, Kristine M Nacion2, Katherine J Deans1
1Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH.
Insights
Sacral nerve stimulation (SNS) shows promising results for pediatric bowel and bladder dysfunction (BBD). Early findings indicate significant improvements in both gastrointestinal and urinary functions, guiding future treatment strategies.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Neuromodulation
Background:
- Bowel and bladder dysfunction (BBD) significantly impacts children's quality of life.
- Current treatment options for BBD have limitations, necessitating novel therapeutic approaches.
- Sacral nerve stimulation (SNS) is an emerging treatment modality for complex BBD cases.
Purpose of the Study:
- To evaluate the outcomes of sacral nerve stimulation (SNS) in pediatric patients with BBD.
- To identify patient characteristics associated with successful SNS outcomes.
- To inform the development of future BBD therapies.
Main Methods:
- A prospective registry collected data on 29 pediatric BBD patients before and after SNS implantation.
- Utilized validated patient-reported outcome measures including the Fecal Incontinence Quality of Life Scale and PedsQL.
- Collected clinical data on etiology, symptoms, and treatment response.
Main Results:
- 93% of patients presented with GI complaints and 65.5% with urinary symptoms.
- SNS led to significant improvements in patient-reported GI and urinary function.
- 55% of patients with pre-SNS cecostomy tubes achieved voluntary bowel movements, and 91% discontinued anticholinergic medication for bladder overactivity.
Conclusions:
- Sacral nerve stimulation (SNS) demonstrates early efficacy in improving both gastrointestinal and urinary function in pediatric BBD.
- SNS offers a viable treatment option for children with refractory BBD.
- Further research is warranted to optimize SNS patient selection and long-term outcomes.
Purpose:
This study describes our series of children with bowel and bladder dysfunction (BDD) treated with sacral nerve stimulation in order to begin to identify characteristics associated with better outcomes and guide future therapies.
Methods:
Between May 2012 and February 2014, 29 patients were evaluated before and after sacral nerve stimulator (SNS) placement. A prospective data registry was developed that contains clinical information and patient-reported measures: Fecal Incontinence Qualify of Life Scale, Fecal Incontinence Severity Scale, PedsQL Gastrointestinal Symptom Scale, and Vancouver DES Symptom Scale.
Results:
The median age of patients was 12.1 (interquartile range: 9.4, 14.3) years and the median follow-up period was 17.7 (12.9, 36.4) weeks. 93% had GI complaints and 65.5% had urinary symptoms while 7% had urologic symptoms only. The most common etiologies of BBD were idiopathic (66%) and imperforate anus (27%). Five patients required reoperation due to a complication with battery placement. Six of 11 patients (55%) with a pre-SNS cecostomy tube no longer require an antegrade bowel regimen as they now have voluntary bowel movements. Ten of eleven patients (91%) no longer require anticholinergic medications for bladder overactivity after receiving SNS. Significant improvements have been demonstrated in all four patient-reported instruments for the overall cohort.
Conclusions:
Early results have demonstrated improvements in both GI and urinary function after SNS placement in pediatric patients with bowel and bladder dysfunction.
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