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Pediatric sacral neuromodulation: A step-by-step tined lead placement technique and clinical outcomes
A Faure1, C Giannopoulou1, M Haddad1
1APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France.
Introduction:
Chronic stimulation of the sacral nerves has become one of the most accepted non-invasive treatments for non-neurogenic lower urinary tract dysfunction in children. The International Children's Continence Society recently recognized sacral neuromodulation (SNM) as a viable option for treating urinary incontinence related to overactive bladder (OAB) and urgency. Proper placement of the electrodes is a key factor in optimizing clinical outcomes.
Objective:
We present a video that offers a step-by-step demonstration of the tined lead placement technique in children and share our experience with this procedure in a pediatric cohort.
Study Design:
Retrospective, non-randomized study.
Results:
Since 2020, seven children have undergone SNM for idiopathic OAB (n = 4, median age: 8.5 years) and chronic non-neurogenic urinary retention (n = 3, median age: 16 years). Six of the seven children progressed to permanent implantation after a successful test phase. The median follow-up duration was 39 months (8-48) and 18 months (18-42) respectively in the OAB and urinary retention group. All children were successfully treated. Two patients required surgical revision due to wound infection and device dysfunction. The SNM device was removed in one patient, with no recurrence of OAB symptoms.
Discussion:
Key elements of tined lead placement include identifying radiological landmarks, guiding the electrode into the sacral foramen, and ensuring its correct progression. Placement is based on fluoroscopic appearance of the electrodes and achieving motor and sensory responses during stimulation. These factors contribute to the positive clinical outcomes seen in our pediatric cohort.
Conclusion:
SNM appears to be an effective and minimally invasive treatment option for pediatric patients with non-neurogenic vesico-sphincter disorders that are resistant to first-line therapies. Standardization of the surgical technique is essential for optimizing patient outcomes and maximizing the therapeutic potential of SNM.
