Sacral neuromodulation (SNM) in children: Results of a multicentric study

Purpose We present the final results of a multicentric prospective study to evaluate the effect of SNM in the management of urinary incontinence and bowel dysfunction in children. Material and methods We included patients between the ages of 5 and 25 years presenting urinary incontinence due to neurogenic bladder associated or not to fecal incontinence due to congenital malformations. After acute stimulation, patients were implanted on the S3 foramen. Clinical examination, voiding and bowel diaries, urodynamic and manometric evaluations were done every 3 months. Design of the study was a cross over one. Statistics used the student and chi2 tests. Results A total of 33 patients (24 boys) were included. Mean age was 12,22 years. Etiologies were spina bifida and sacral agenesis. Incontinence was mixed (urinary and fecal) in 19, only urinary in 9 and only fecal in 5. The leak point pressure and the total bladder capacity increased during SNM (+27,86 and +31,86 versus -41,05 and -31: p = 0,005 and p = 0,04 respectively).There was no significant difference concerning the other urodynamic and manometric parameters. Global clinical improvement (including success) was more than 70% in each of urinary and bowel functions. However, successful results were better regarding bowel function (success = 32% versus 8%). In cross over analysis there is a strong evidence that SNM is clinically more efficacious than conservative treatment in each type of incontinence p = 0,002 (10 patients have the association « SNM = success, control = failure versus 0 « SNM = failure, control = success »). Conclusions Sacral neuromodulation has a beneficial effect on both bladder and bowel dysfunctions.