Guys JM et al. (2004) Sacral neuromodulation for neurogenic bladder dysfunction in children. J Urol 172: 1673–1676

In children, neurogenic bladder dysfunction is managed medically and using various surgical approaches. A recent study by Guys et al. has investigated whether the technique of sacral neuromodulation (SNM) may be useful in this setting.

A total of 42 patients aged 5–21 years were included in the study. After testing for appropriate responses to stimulation of the S3 nerve, patients were randomized to SNM or conventional treatment, with 21 patients in each group. Patients randomized to SNM underwent implantation of the permanent neurostimulator unit and lead immediately after testing. Those in the conventional treatment (control) group received anticholinergics, antibiotics and bulking agents as necessary, but were not treated surgically during the study period. Patients were evaluated at 3, 6, 9 and 12 months.

There were no statistically significant differences in urodynamic variables between the SNM and control groups, with two exceptions: better bladder capacity in the control group at 12 months, and higher leak point pressure in the SNM group at all time points. Patients in the SNM group showed significant improvements in compliance and functional bladder capacity at 6 and 9 months, compared to baseline. Other than three cases of revision surgery (resulting from lead migration, faulty connection or wound infection), there were no complications associated with the SNM procedure.

Although conclusions could not be drawn regarding the potential benefit of SNM, the authors note that the results were encouraging and that a larger study is ongoing.