[Chronic sacral neuromodulation for pelvic floor dysfunction in children with spina bifida]

Area of Science:

• Pediatric Urology
• Neurology
• Biomedical Engineering

Background:

• Neurogenic lower urinary tract dysfunction (NLUTD) is a common complication in children with spina bifida.
• Conservative treatments often fail, necessitating advanced therapeutic interventions.
• Sacral neurostimulation offers a potential solution for managing complex bladder issues in this population.

Purpose of the Study:

• To evaluate the effectiveness of chronic sacral neuromodulation in pediatric patients with spina bifida and NLUTD.
• To assess the impact of sacral neurostimulation on urinary symptoms and urodynamic parameters.
• To compare outcomes between different subtypes of NLUTD treated with sacral neurostimulation.

Main Methods:

• A cohort of eight pediatric patients with spina bifida and refractory NLUTD underwent sacral neurostimulation.
• Surgical implantation of a quadripolar test electrode targeted the S3 sacral nerve root.
• Efficacy was assessed through clinical symptom evaluation, urinary diaries, PAD tests, and urodynamic studies.

Main Results:

• Five patients demonstrated a positive response to test stimulation and proceeded to chronic implantation.
• Significant improvements were observed in urinary leakage, bladder capacity, and frequency of catheterization.
• Patients with detrusor-sphincter dyssynergia showed better outcomes than those with detrusor overactivity.

Conclusions:

• Chronic sacral neuromodulation is a viable treatment option for pediatric NLUTD in spina bifida.
• The procedure demonstrated preliminary efficacy in improving bladder management and quality of life.
• Sacral neuromodulation offers a promising therapeutic avenue, with specific patient profiles exhibiting superior responses.