Sacral nerve stimulator success after filum section for refractory dysfunctional voiding.

Area of Science:

• Pediatric Urology
• Neuro-urology
• Minimally Invasive Surgery

Background:

• Filum section (FS) is a treatment for tethered cord syndrome in pediatric patients with refractory dysfunctional voiding (DV).
• Previous reports suggest symptom improvement after FS, even with normal spinal MRI, but its efficacy is debated.
• Current practice involved neurosurgical evaluation for MRI and potential FS for DV.

Purpose of the Study:

• To evaluate the safety and efficacy of sacral nerve stimulator (SNS) placement in pediatric patients with refractory DV following failed FS.
• Primary outcome: complications and explantations.
• Secondary outcome: changes in quality of life.

Main Methods:

• Retrospective review of pediatric patients (<18 years) undergoing second-stage SNS after FS (November 2012 - December 2019).
• Data collected on second-stage implantation, complications, and explantations.
• Preoperative and postoperative quality of life assessed using the PedsQL™ questionnaire; statistical analysis via paired t-test.

Main Results:

• 23 children underwent second-stage SNS due to persistent symptoms post-FS; median age 10.3 years.
• No intraoperative complications; median follow-up 2.8 years.
• Significant improvement in PedsQL™ scores (61.7 to 86.7, p < 0.0001) in 15 patients completing questionnaires; 17.4% experienced lead revisions.

Conclusions:

• Sacral nerve stimulator (SNS) placement following filum section (FS) is feasible and safe for pediatric refractory dysfunctional voiding (DV).
• SNS significantly improves patient-reported quality of life, comparable to other pediatric SNS cohorts.
• Practice has shifted to offering SNS for refractory DV with normal MRI, with FS considered for MRI abnormalities prior to SNS.