Sacral nerve stimulation for constipation and fecal incontinence in children: Long‐term outcomes, patient benefit, and parent satisfaction

Lu, Peter L.; Koppen, Ilan J.N.; Orsagh-Yentis, Danielle; Leonhart, Karen; Ambeba, Erica J.; Deans, Katherine J.; Minneci, Peter C.; Teich, Steven; Diefenbach, Karen A.; Alpert, Seth A.; Benninga, Marc A.; Yacob, Desalegn; Lorenzo, Carlo Di

doi:10.1111/nmo.13184

Cited by 48 publications

(27 citation statements)

References 26 publications

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“…Baseline evaluation of patients was reported heterogeneously within the different papers; clinical examination, All the published studies reported a two-stage technique of implant for ISNM, as previously described. [6][7][8][9][10][11][12] The first stage is the diagnostic stage for which two possible options are available: temporary wire or tined lead. Following the testing period of generally 2 to 3 weeks, patients received the definitive implant in which the implantable stimulator was implanted.…”

Section: Results: Invasive Neuromodulation Technique-isnmmentioning

confidence: 99%

“…Criteria for definitive implant were more than 50% improvement in the baseline symptoms 7 and more than three time increase in defecation frequency per week. 8,9 Haddad et al 10 in their crossover study divided the patients as responders or nonresponders regarding the fecal performance; the response was defined as resolution of fecal soiling with no need for pads or a decrease of more than 50% in the numbers of leaks or soiling episodes. Overall, a positive response rate was more than 75%, indicating that neuromodulation was more effective than conservative treatment of fecal incontinence.…”

Section: Results: Invasive Neuromodulation Technique-isnmmentioning

confidence: 99%

“…Measured outcomes such as the abdominal pain score or the straining improved and incomplete defecation also decreased. Lu et al8…”

mentioning

confidence: 99%

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Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review

2019

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Background Neuromodulation is the application of electrical stimulation on nerve fibers to modulate the neuronal activity. Its use for chronic constipation and fecal incontinence has increased in popularity over the past few years. Invasive and noninvasive techniques are currently available. We reviewed the current literature on the application of the neuromodulation techniques in the management of chronic constipation and fecal incontinence in children. Materials and Methods A search of Healthcare Database Advanced Search, Embase, Medline, and Cochrane database was performed in accordance with PRISMA guideline. Terms used in the search included neuromodulation, nerve stimulation, fecal/fecal incontinence, incontinence, constipation, children, and pediatric/pediatric. Results Two-hundred forty-one papers were screened. Fourteen papers were included for the systematic review: seven were selected for the ISNM (implantable sacral nerve modulation) technique, one for the transcutaneous tibial nerve stimulation), one for the transcutaneous sacral nerve modulation), and five for the transcutaneous interferential sacral nerve stimulation. Results showed an overall improvement in constipation symptoms in 79 to 85.7% of patients, resolution of symptoms in 40%, reduced use of ACE stoma/transanal irrigation system in 12.5 to 38.4%, and improvement in incontinence symptoms in 75%. High complication rate was reported (17–50%) in the ISNM group. No complications were reported in the non-invasive group. Conclusion Neuromodulation is a promising tool in the management of constipation refractory to medical treatment and fecal incontinence in children. Noninvasive techniques provide good results with no complications. A longer term follow-up will provide more information regarding patient compliance and sustainability of benefits of these new techniques.

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Section: Results: Invasive Neuromodulation Technique-isnmmentioning

confidence: 99%

Section: Results: Invasive Neuromodulation Technique-isnmmentioning

confidence: 99%

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Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review

2019

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“…One wonders, if this effect is sustained, perhaps future, adult LUTS with initial treatment in childhood could be altered or eliminated. Explant surveys for those explanted for cure and complication.^Raw scores in the cure cohort were 5,8,9,15,16. * Based upon cut-off score of 11 suggested by Afsar et al [12].…”

Section: Discussionmentioning

confidence: 99%

Pediatric sacral nerve stimulator explanation due to complications or cure: a survival analysis

Rensing

Szymański

Dunn

et al. 2019

Journal of Pediatric Urology

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“…A significant improvement in symptoms and quality of life was reported at a median of 4-5 months after SNS initiation. In a follow-up study, SNS led to continued improvement in both symptoms and quality of life at 2 years after treatment initiation, with particular improvement in concurrent fecal incontinence [56]. At follow-up, 68% of patients fulfilled the predefined criteria for successful response and 24% fulfilled criteria without concurrent laxative or ACE use.…”

Section: Neuromodulationmentioning

confidence: 96%

Controversies in the Management of Functional Constipation in Children

Mill

Koppen

Benninga

2019

Curr Gastroenterol Rep

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Purpose of review Functional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5 years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre-and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrounding them. Recent findings Pre-and probiotics and prucalopride are not effective in the treatment of childhood constipation. Pelvic physiotherapy and sacral nerve stimulation are promising treatment options but larger trials are needed. Surgery for pediatric constipation is the treatment of last resort. Summary Large, well-designed placebo-controlled trials with proper outcome measures, as suggested by the Rome foundation pediatric subcommittee on clinical trials, are necessary to provide more insight regarding the efficacy of new treatments in childhood constipation.

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Sacral nerve stimulation for constipation and fecal incontinence in children: Long‐term outcomes, patient benefit, and parent satisfaction

Cited by 48 publications

References 26 publications

Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review

Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review

Pediatric sacral nerve stimulator explanation due to complications or cure: a survival analysis

Controversies in the Management of Functional Constipation in Children

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