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[Prolonged spinal and sacral neurostimulation in children with pelvic organ dysfunction: preliminary analysis]
A G Timershin1,2, D V Kreshchenok1, S A Konovalov1
1Republican Children's Clinical Hospital, Ufa, Russia.
Insights
Long-term spinal and sacral neurostimulation effectively treats bladder and bowel dysfunction in children with myelodysplasia. This therapy improves quality of life by reducing incontinence and catheterization needs.
Area of Science:
- Neurosurgery
- Pediatric Urology
- Neurology
Context:
- Myelodysplasia often leads to chronic bladder and bowel dysfunction in children.
- Previous therapies, including botulinum therapy, were ineffective for these patients.
- Exclusion of tethered spinal cord syndrome was a prerequisite for participation.
Purpose:
- To evaluate the clinical efficacy of long-term spinal and sacral programmable neurostimulation for pelvic organ dysfunction.
- To assess the impact of neurostimulation on bladder and rectal function in pediatric patients with myelodysplasia.
Summary:
- A retrospective study of 32 children (ages 1-17) with myelodysplasia and pelvic organ dysfunction demonstrated significant improvements with epidural spinal and sacral stimulation.
- Key outcomes included increased urine volume (from 131.5 to 236 ml), decreased intravesical pressure (by 20.3%), reduced urinary leakage and fecal incontinence episodes, and a 51.1% decrease in daily bladder catheterizations.
- Patient satisfaction was high, with 26 out of 32 reporting moderate to very high satisfaction.
Impact:
- Chronic epidural spinal and sacral stimulation offers a viable and effective treatment option for improving quality of life in pediatric patients with myelodysplasia-related pelvic organ dysfunction.
- This neurostimulation technique demonstrates significant clinical benefits for chronic bladder and bowel management in this challenging patient population.
Objective:
To evaluate the clinical efficacy of long-term spinal and sacral programmable neurostimulation for pelvic organ dysfunction in patients with myelodysplasia and chronic dysfunction of the bladder and rectum.
Material And Methods:
A retrospective study included 32 children aged 1-17 years (mean 10.7) with myelodysplasia, pelvic organ dysfunction and ineffective therapy including botulinum therapy and exclusion of tethered spinal cord syndrome. All children underwent comprehensive urodynamic examination with analysis of bladder and residual urine volume, mean flow rate, intravesical pressure and total urine volume, as well as electromyographic examination. Examination was carried out before surgery, after 6, 12 and 36 months. We applied urinary diary, NBSS questionnaire and urodynamic examination data. All patients underwent neurological examinations (neurological status, magnetic resonance imaging of the spinal cord, computed tomography and radiography of the spine, electroneuromyography). The study was conducted at the neurosurgical department of the Republican Children's Clinical Hospital in Ufa between 2014 and 2022. There were 32 implantations of epidural neurostimulators for pelvic organ dysfunctions.
Results:
Patients used epidural spinal and sacral stimulation up to 6 times a day for 10-15 min turning on the pulse generator. This method significantly increased urinary volume, decreased episodes of urinary leakage and fecal incontinence, residual volume after urination and number of periodic catheterizations compared to baseline data. Sixteen patients were very satisfied, 10 ones were moderately satisfied, and 2 patients were not satisfied with therapy. The number of bladder catheterizations per day decreased by 51.1%. Urine volume significantly increased from 131.5±16.1 to 236±16.7 ml, intravesical pressure decreased from 23.5±4.2 to 18.5±2.1 cm H2O (by 20.3%).
Conclusion:
Chronic epidural spinal and sacral stimulation can improve the quality of life in patients with pelvic organ dysfunction. This technique may be effective for pelvic organ dysfunction caused by myelodysplasia.
