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Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms : 15-year experience

LUITZEN ALBERT GROEN (UGent) , Piet Hoebeke (UGent) , Nele Loret (UGent) , Charles Van Praet (UGent) , Erik Van Laecke (UGent) , Ann Raes (UGent) , Johan Vande Walle (UGent) and Karel Everaert (UGent)
(2012) JOURNAL OF UROLOGY. 188(4). p.1313-1317
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Abstract
Purpose: Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method. Materials and Methods: A total of 18 children 9 to 17 years old were studied. Mean +/- SD followup was 28.8 +/- 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning). Results: Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean +/- SD number of incontinence episodes weekly improved significantly from 23.2 +/- 12.4 to 1.3 +/- 2.63 (p < 0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean +/- SD daily frequency of catheterization from 5.2 +/- 1.6 to 2.0 +/- 1.9 (p < 0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure. Conclusions: Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.
Keywords
urinary bladder, overactive, neurogenic, pediatrics, implantable neurostimulators, urination disorders, DYSFUNCTIONAL ELIMINATION SYNDROME, NEUROGENIC BLADDER DYSFUNCTION, NERVE-STIMULATION

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Chicago
GROEN, LUITZEN ALBERT, Piet Hoebeke, Nele Loret, Charles Van Praet, Erik Van Laecke, Ann Raes, Johan Vande Walle, and Karel Everaert. 2012. “Sacral Neuromodulation with an Implantable Pulse Generator in Children with Lower Urinary Tract Symptoms : 15-year Experience.” Journal of Urology 188 (4): 1313–1317.
APA
GROEN, L. A., Hoebeke, P., Loret, N., Van Praet, C., Van Laecke, E., Raes, A., Vande Walle, J., et al. (2012). Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms : 15-year experience. JOURNAL OF UROLOGY, 188(4), 1313–1317.
Vancouver
1.
GROEN LA, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Raes A, et al. Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms : 15-year experience. JOURNAL OF UROLOGY. 2012;188(4):1313–7.
MLA
GROEN, LUITZEN ALBERT et al. “Sacral Neuromodulation with an Implantable Pulse Generator in Children with Lower Urinary Tract Symptoms : 15-year Experience.” JOURNAL OF UROLOGY 188.4 (2012): 1313–1317. Print.
@article{3058485,
  abstract     = {Purpose: Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method. 
Materials and Methods: A total of 18 children 9 to 17 years old were studied. Mean +/- SD followup was 28.8 +/- 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning). 
Results: Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean +/- SD number of incontinence episodes weekly improved significantly from 23.2 +/- 12.4 to 1.3 +/- 2.63 (p < 0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean +/- SD daily frequency of catheterization from 5.2 +/- 1.6 to 2.0 +/- 1.9 (p < 0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure. 
Conclusions: Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.},
  author       = {GROEN, LUITZEN ALBERT and Hoebeke, Piet and Loret, Nele and Van Praet, Charles and Van Laecke, Erik and Raes, Ann and Vande Walle, Johan and Everaert, Karel},
  issn         = {0022-5347},
  journal      = {JOURNAL OF UROLOGY},
  keywords     = {urinary bladder,overactive,neurogenic,pediatrics,implantable neurostimulators,urination disorders,DYSFUNCTIONAL ELIMINATION SYNDROME,NEUROGENIC BLADDER DYSFUNCTION,NERVE-STIMULATION},
  language     = {eng},
  number       = {4},
  pages        = {1313--1317},
  title        = {Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms : 15-year experience},
  url          = {http://dx.doi.org/10.1016/j.juro.2012.06.039},
  volume       = {188},
  year         = {2012},
}

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