Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A 10-Year Single-center Experience With 105 Consecutive Children

Sacral Neuromodulation in Children

“…Based on our experience and current literature, SNM should only be considered in children who have failed an extended period of behavioral modification, biofeedback, and pharmacologic therapy [9][10][11][12][13][14][15]. Several groups have also offered intravesical botulinum toxin A, transcutaneous electrical nerve stimulation, and percutaneous tibial nerve stimulation to this population of children but have not required them to fail these less invasive therapies prior to SNM [13,15].…”

“…Several groups have also offered intravesical botulinum toxin A, transcutaneous electrical nerve stimulation, and percutaneous tibial nerve stimulation to this population of children but have not required them to fail these less invasive therapies prior to SNM [13,15].…”

“…Several groups have excluded children with neurologic diseases or spinal deformities in their series [10,11,14,15]. Significant spinal deformities may complicate or even prohibit lead placement in the foramen of the third sacral spinal nerve (S3).…”

“…Certain groups have required an objective symptomatic improvement during the trial, whereas others have made a subjective determination or not reported their criteria to undergo IPG implantation in their series [10,11,[13][14][15]. There are no established criteria for a successful trial.…”

“…There are no established criteria for a successful trial. Dwyer et al required at least a 50% symptomatic improvement in a bladder and bowel diary when compared to a preoperative diary [15]. Alternatively, Groen et al required at least a 50% decrease in the episodes of urinary incontinence, post-void residual volume, need for CIC, and frequency in their series [13].…”