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Yang M, Gao S, Yao H, He X, Fang J, Chen Y, Liu Z. Effects of electroacupuncture on pediatric chronic urinary retention: a case-series study. Front Pediatr 2023; 11:1194651. [PMID: 37547105 PMCID: PMC10401264 DOI: 10.3389/fped.2023.1194651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives This study aims to preliminarily evaluate the effect and safety of electroacupuncture (EA) in treating pediatric chronic urinary retention (CUR) following lumbosacral surgeries, with treatment duration evaluated. Methods This prospective case-series study was performed from August 5, 2017, to July 31, 2022. Pediatric patients diagnosed with CUR following lumbosacral surgeries were included and treated by EA for 2-16 weeks. Responders were defined as participants achieving a reduction of 50% or more in post void residuals (PVR) from baseline. Time-to-event analysis was applied to explore the association between EA treatment duration and response rate. Adverse event was recorded. Results Totally 14 participants (mean [SD] age, 12 [4] years) completed EA treatment. Response rate was 71% (10/14) at the 12th week. 50% (7/14) of participants removed catheters at the 12th week, and none of them experienced re-catheterization in the 24-week follow-up. No serious adverse event was reported. Time-to-event analysis estimated that over 50% patients could respond to EA of more than 8 weeks. Subgroup analysis showed that participants with baseline PVR ≥300 ml and CUR duration ≥12 months experienced longer EA duration to reach the response rate of 50%, compared with those whose PVR <300 ml and CUR duration <12 months (median value: 12 weeks vs. 8 weeks, 12 weeks vs. 4 weeks, respectively). Conclusions EA could reduce PVR for pediatric patients suffering from CUR following lumbosacral surgeries, with long-term efficacy and safety. EA treatment of more than 8 weeks was reasonable. Further study of a larger sample and controlling is needed. Clinical Trial Registration www.chictr.org.cn, identifier, ChiCTR1800020222.
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Affiliation(s)
- Min Yang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuai Gao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xin He
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jiufei Fang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Chen
- Beijing Houpo Chinese Medicine Institute, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Shim J, Oh MM. Updates of Overactive Bladder in Pediatrics. Int Neurourol J 2023; 27:3-14. [PMID: 37015720 PMCID: PMC10073000 DOI: 10.5213/inj.2244228.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 04/06/2023] Open
Abstract
Overactive bladder (OAB) is clinically defined as urinary urgency with or without urinary incontinence. It is associated with daytime frequency or constipation and has a prevalence of approximately 5%-12% among 5- to 10-year-olds. The appropriate functional exchange between the pontine micturition center, periaqueductal gray matter, and prefrontal cortex is important for proper micturition control. Several studies on pediatric cases observed a link between OAB and neuropsychiatric problems, such as anxiety, depression, and attention deficit, and treatment of these comorbidities improved patient symptoms. In this review, we present the pathophysiology of OAB, its associated conditions, and aspects related to updates in OAB treatment, and we propose a step-by-step treatment approach following this sequence: behavioral therapy, medical treatment, and invasive treatment. Although anticholinergic drugs are the mainstay of OAB medical treatment, beta-3 agonists and alpha-blockers are now recommended as a result of significant advancements in pharmacologic treatment in the last 10 years. Electrical stimulation techniques and botulinum toxin are also effective and can be used, especially in conventional treatment-refractory cases.
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Affiliation(s)
- Jisung Shim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, College of Medicine, Korea University, Seoul, Korea
| | - Mi Mi Oh
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: A urologist's perspective. Low Urin Tract Symptoms 2022; 14:132-139. [PMID: 35233967 DOI: 10.1111/luts.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow-up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Role of Pelvic Organ Crosstalk in Dysfunction of the Bowel and Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kucherov V, Truong H, Raab C, Hagerty JA. Urologic presentations and management options in pediatric mitochondrial disease. Urology 2022; 164:230-237. [PMID: 35016974 DOI: 10.1016/j.urology.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/27/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the evaluation and management of urologic pathology related to mitochondiral diseases (MD) in childhood. METHODS A retrospective review was performed of patients with MD from 1/1/2000 - 10/8/2020 who were referred for urologic evaluation at a single childrens hospital. Clinical and demographic information was reviewed including symptomatology, urodynamic evaluation, and medical/surgical management. RESULTS 15 patients were identified for inclusion. Median age of presentation was 5 years and median follow up was 4 years. Patients presented with numerous urologic complaints including urinary retention/incomplete emptying, incontinence, and recurrent urinary tract infection. Urodynamics demonstrated elevated median bladder capacity at 172% of expected as calculated by age. Detrusor sphincter dyssynergia (DSD) was present in 6 (50%). Progression to surgical intervention occurred in 67% at a median time of 3.5 years after initial referral. This included suprapubic tube (SPT) placement and sacral neuromodulation (SNM). CONCLUSIONS Patients in this study were found to have a spectrum of lower urinary tract dysfunction (LUTD) with elevated bladder capacity being common. No singular urodynamic feature prevailed although DSD was found in 50%. Progression of symptoms over time was also common. Most patients (67%) did go on to surgical intervention including SPT and SNM. Clinicians should be aware of the possibility of LUTD in children with MD and they should be promptly referred to pediatric urology when LUTD is suspected.
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Affiliation(s)
- Victor Kucherov
- Department of Urology, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107.
| | - Hong Truong
- Department of Urology, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107.
| | - Christopher Raab
- Division of Diagnostic Referral, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803.
| | - Jennifer A Hagerty
- Division of Pediatric Urology, Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803.
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Dekopov AV, Tomskiy AA, Isagulyan ED, Yurasov IS, Salyukova YR, Salyukov RV. [Chronic sacral neuromodulation for pelvic floor dysfunction in children with spina bifida]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:48-55. [PMID: 35170276 DOI: 10.17116/neiro20228601148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the effectiveness of chronic sacral neurostimulation for neurogenic lower urinary tract dysfunction in children with spina bifida. MATERIAL AND METHODS Eight patients with spina bifida and neurogenic lower urinary tract dysfunction underwent surgical treatment. Three patients had detrusor-sphincter dyssynergia and urinary incontinence. Five patients had detrusor overactivity and urine retention. Conservative treatment was failed in all cases. We implanted quadripolar test electrode on the S3 root through Tuohy needle under fluoroscopic control. Test stimulation was ineffective in three children with detrusor overactivity. Five patients with positive response to stimulation underwent implantation of chronic neurostimulation system. We estimated the efficacy of neurostimulation considering symptoms of neurogenic lower urinary tract dysfunction, urinary diary, PAD test and complex urodynamic examination data. RESULTS Positive clinical effects were observed in 3 patients with detrusor-sphincter dyssynergia and 2 patients with detrusor overactivity. Clinical effect included improvement in urine leakage and higher bladder volume. In patients with urinary retention, we revealed voluntary urination and less number of daily catheterization procedures. In one patient, clinical effect of chronic stimulation regressed within 3 month after surgery. CONCLUSION Preliminary results of chronic sacral neuromodulation confirmed its advisability in children with neurogenic lower urinary tract dysfunction. Patients with detrusor-sphincter dyssynergia had better results compared to those with detrusor overactivity.
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Affiliation(s)
- A V Dekopov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A A Tomskiy
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I S Yurasov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - R V Salyukov
- Peoples' Friendship University of Russia, Moscow, Russia
- Rehabilitation Center for Disabled Persons «Preodolenie», Moscow, Russia
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Boswell TC, Hollatz P, Hutcheson JC, Vandersteen DR, Reinberg YE. Device outcomes in pediatric sacral neuromodulation: A single center series of 187 patients. J Pediatr Urol 2021; 17:72.e1-72.e7. [PMID: 33129672 DOI: 10.1016/j.jpurol.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pediatric sacral neuromodulation (SNM) device duration before revision or removal is not well known. Furthermore, secondary surgeries serve as surrogates for key outcomes including complications and symptom improvement. OBJECTIVE We sought to study the rate and causes of secondary surgeries in pediatric SNM patients. STUDY DESIGN We assessed our cohort of pediatric SNM patients for secondary surgeries (revision or removal). Baseline patient characteristics associated with secondary surgery were analyzed with Fisher's exact test. Kaplan-Meier analysis was used to describe secondary-surgery-free device survival. RESULTS 187 pediatric patients underwent sacral neuromodulation at our institution between 2002 and 2019. 7 (4%) patients did not have a permanent device placed due to poor response during an externalized lead trial period, leaving 180 patients with permanent implanted devices. Over a median follow-up of 3.9 years (IQR 2.0 to 6.3), there were 154 total secondary surgeries. There were 83 device revisions, with 89% of revisions for a non-functioning device, 8% for pain, and 2% for infection. Of the non-functioning devices, 11% were due to battery depletion and the rest were due to lead fracture or dislodgement. Permanent device removal was performed in 71 (39%) patients, with 38% of these for unfavorable reasons (6% infection, 8% pain, 24% no longer effective) and 62% for favorable reasons (symptom improvement or resolution). Of patient baseline characteristics, only device duration was associated with favorable removal (p < 0.01). On Kaplan-Meier analysis, 5 year device secondary-surgery-free survival was 32% for any secondary surgery (favorable or unfavorable) and was 47% for unfavorable secondary surgery. At last follow-up, 74% of patients were in a favorable position (using the device, trialing with device off, or device had been removed for improvement) while 26% of patients were requiring other treatments due to device problem or removal. DISCUSSION Describing the likelihood of subsequent surgery is an important aspect of patient and guardian counseling concerning pediatric SNM. Our cohort had a 68% 5 year all-cause reoperation rate. However, in a theoretical perfect world, pediatric SNM reoperation rate would be 100% after adequate follow-up (either for battery replacement, or device explantation for improvement). CONCLUSIONS While sacral neuromodulation in our cohort of children carried a high (68% 5-year) reoperation rate (whether for complication or symptom improvement), the majority (74%) of these patients with previously refractory symptoms either continue to use their device or have had significant symptom improvement to permit device removal at moderate-term (median 3.9 year) follow-up.
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Affiliation(s)
| | - Pam Hollatz
- Children's Hospitals and Clinics of Minnesota, Pediatric Surgical Associates, Minneapolis, MN, USA.
| | - Joel C Hutcheson
- Children's Hospitals and Clinics of Minnesota, Pediatric Surgical Associates, Minneapolis, MN, USA.
| | - David R Vandersteen
- Children's Hospitals and Clinics of Minnesota, Pediatric Surgical Associates, Minneapolis, MN, USA.
| | - Yuri E Reinberg
- Children's Hospitals and Clinics of Minnesota, Pediatric Surgical Associates, Minneapolis, MN, USA.
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Averbeck MA, Moreno-Palacios J, Aparicio A. Is there a role for sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction? Int Braz J Urol 2021; 46:891-901. [PMID: 32758301 PMCID: PMC7527110 DOI: 10.1590/s1677-5538.ibju.2020.99.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To review current literature regarding sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD) focused on indications, barriers and latest technological developments. MATERIAL AND METHODS A PubMed database search was performed in April 2020, focusing on SNM and various neuro-urological conditions. RESULTS SNM has been increasingly indicated for lower urinary tract dysfunction (LUTD) in neuro-urological patients. Most studies are cases series with several methodological limitations and limited follow-up, lacking standardized definition for SNM clinical success. Most series focused on neurogenic overactive bladder in spinal cord injured (incomplete lesions) and multiple sclerosis patients. Barriers for applying this therapy in neurogenic LUTD were mainly related to magnetic resonance imaging incompatibility, size of the implantable pulse generator (IPG), and battery depletion. Newer technological advances have been made to address these limitations and will be widely available in the near future. CONCLUSIONS SNM seems a promising therapy for neurogenic LUTD in carefully selected patients with incomplete lesions. Further studies are still needed to define which subgroups of neurological patients benefit the most from this minimally invasive technique.
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Affiliation(s)
- Marcio Augusto Averbeck
- Coordenador de Neurourologia, Unidade de Videourodinâmica, Moinhos de Vento Hospital, Porto Alegre, RS, Brasil
| | - Jorge Moreno-Palacios
- Servicio de Urologia, Unidad de Alta Especialidad Centro Médico Nacional Siglo XXI, IMSS, México, MX
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Dos Santos J, Marcon E, Pokarowski M, Vali R, Raveendran L, O'Kelly F, Amirabadi A, Elterman D, Foty R, Lorenzo A, Koyle M. Assessment of Needs in Children Suffering From Refractory Non-neurogenic Urinary and Fecal Incontinence and Their Caregivers' Needs and Attitudes Toward Alternative Therapies (SNM, TENS). Front Pediatr 2020; 8:558. [PMID: 33014941 PMCID: PMC7509042 DOI: 10.3389/fped.2020.00558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Non-neurogenic urinary and fecal incontinence (UI, FI) affects approximately 6% of North American children with 1% of cases becoming refractory (nonresponsive to standard therapies). Incontinence has major potential long-term physiological and psychological implications for patients and their families. While Sacral Neuromodulation (SNM) and Transcutaneous Nerve Stimulation (TENS) are alternative therapies available for the treatment of refractory UI/FI, these are not approved for use in children in Canada. The present study assessed participants' perception of current treatments, incontinence burden, and attitudes toward novel therapies in a single pediatric institution. Methods: Multiple validated questionnaires including Dysfunctional Voiding Scoring System (DVSS), Bristol Stool Chart (BSC), Pediatric Incontinence measurement (PinQ), and Time-Driven Activity Based Costing were used to perform a needs assessment for patients with non-neurogenic refractory incontinence, and to determine patients' and caregivers' attitudes toward alternative therapies. Results: 75% of patients and 89% of caregivers reported a moderate to severe impact of incontinence on QoL with diminished social interactions among the primary concerns. Caregivers were frustrated with current treatments and were open to trying alternative therapies (SNM and TENS), which, at least in the case of SNM, seems to be less expensive, possibly less burdensome and more effective than current surgical options. Conclusion: Pediatric refractory UI/FI has a large impact on patients' and caregivers' QoL and alternative therapies with the potential to improve QoL of patients and caregivers should be further investigated as a substitute for surgery.
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Affiliation(s)
- Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Edyta Marcon
- Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Donnelly Centre, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Reza Vali
- Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lucshman Raveendran
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Afsaneh Amirabadi
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dean Elterman
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Richard Foty
- Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Armando Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Apostolidis A. Is there enough evidence to support sacral neuromodulation as a viable treatment option in children and adolescents with neurogenic lower urinary tract dysfunction? World J Urol 2019; 37:2811-2812. [DOI: 10.1007/s00345-019-02832-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022] Open
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Sacral neuromodulation in congenital lumbo-sacral and traumatic spinal cord defects with neurogenic lower urinary tract symptoms: a single-center experience in children and adolescents. World J Urol 2019; 37:2775-2783. [PMID: 30864008 DOI: 10.1007/s00345-019-02721-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/02/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study evaluated sacral neuromodulation's effectiveness for managing refractory neuropathic lower urinary tract dysfunction in children and adolescents. METHODS Twenty-five children and adolescents underwent peripheral nerve evaluation test phase of sacral neuromodulation at our center. Thirteen (seven boys and six girls) cases suffered from neuropathic lower urinary tract dysfunction refractory to the maximum medical treatment. The test was done with temporary wire in all patients. Patients with more than 50% improvement in symptoms were chosen for the second stage of implantation of quadripolar tined lead and implantable pulse generator. Bowel transit symptoms were recorded before and after the surgery. RESULTS Eight patients (61.53%; five boys and three girls) had positive responses to the peripheral nerve evaluation test phase. They underwent implantation of permanent quadripolar tined lead and implantable pulse generator. The etiologies were lumbosacral myelomeningocele, occult spina bifida, partial sacral agenesis and incomplete spinal cord injury. Positive clinical response (> 50% improvement in symptoms) was achieved in seven (85%) at a mean follow-up of 14.25 months. Three patients became capable to stop clean intermittent catheterization (P =0.125). The 24-h pad test decreased from 484 to 78 g from before to after the surgery (P =0.043). CONCLUSION This clinical study on a small sample size of children and adolescents demonstrates positive results in short-term follow-up. However, as the procedure is still not approved officially, multicenter studies with more patients can prove the safety and efficacy of sacral neuromodulation in long term among this special group of patients.
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12
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Fuentes M, Magalhães J, Barroso U. Diagnosis and Management of Bladder Dysfunction in Neurologically Normal Children. Front Pediatr 2019; 7:298. [PMID: 31404146 PMCID: PMC6673647 DOI: 10.3389/fped.2019.00298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/04/2019] [Indexed: 12/28/2022] Open
Abstract
Normal bladder and urethral sphincter development as well as neural/volitional control over bladder-sphincter function are essential steps for regular lower urinary tract function. These maturational sequences are clinically evident by the age of 5 years. However, in 17-22% of children, symptoms persist beyond that age, characterizing lower urinary tract dysfunction (LUTD). The clinical spectrum is wide and includes overactive bladder, voiding postponement, underactive bladder, infrequent voiding, extraordinary daytime only urinary frequency, vaginal reflux, bladder neck dysfunction, and giggle incontinence. LUTD may lead to vesicoureteral reflux and recurrent urinary tract infections, increasing the likelihood of renal scarring. LUTD is often associated with constipation and emotional/behavioral disorders such as anxiety, depression, aggressiveness, and social isolation, making diagnosis, and treatment imperative. Diagnosis of LUTD is essentially based on clinical history, investigation of bladder storage, voiding symptoms (urinary frequency, daytime incontinence, enuresis, urgency) and constipation. Dysfunctional Voiding Score System (DVSS) is a helpful tool. Physical examination focuses on the abdomen to investigate a distended bladder or palpable fecal mass, the lumbosacral spine, and reflex testing. Bladder diaries are important for recording urinary frequency and water balance, while uroflowmetry is used to assess voided volume, maximum flow, and curve patterns. Bladder ultrasonography to measure post-void residual urine volume and urodynamics are used as supplemental tests. Current first line treatment is urotherapy, a combination of behavioral measures to avoid postponing micturition, and a restricted diet for at least 2 months. Anticholinergics, β3 agonists and neuromodulation are alternative therapies to manage refractory overactive bladder. Cure rates, at around 40%, are considered satisfactory, with daytime symptoms improving in 32% of cases. Furthermore, children who are also constipated need treatment, preferentially with polyethylene glycol at doses of 1-1.5 g/kg in the 1st 3 days and 0.25-0.5 g/kg thereafter until the 2-month period of behavioral therapy is complete. If urotherapy fails in cases of dysfunctional voiding, the next step is biofeedback to teach the child how to relax the external urethral sphincter during micturition. Success rate is around 80%. Children with underactive bladder usually need a combination of clean intermittent catheterization, alpha-blockers, biofeedback and neuromodulation; however, cure rates are uncertain.
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Affiliation(s)
- Mirgon Fuentes
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
| | - Juliana Magalhães
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
| | - Ubirajara Barroso
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil.,Aliança Hospital, Salvador, Brazil
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Dekopov AV, Tomskiy AA, Salyukov RV, Salyukova YR, Machevskaya OE, Kadyrov SU. [Chronic sacral nerve electrostimulation in treatment of neurogenic pelvic organ dysfunction in children]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:107-111. [PMID: 29795094 DOI: 10.17116/oftalma2018822107-111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Myelodysplasia is the most common cause of congenital pelvic abnormalities in children. The causes of acquired neurogenic pelvic dysfunctions in children include spinal cord injury, myelitis, and neurodegenerative diseases. Urination impairments in children with neurological disorders are a serious clinical problem. In most cases, the capabilities of conservative treatment of pelvic organ dysfunctions are limited. One of the most promising directions in treatment of neurogenic urination disorders is modeling of a lost urination mechanism using direct or mediated electrostimulation of the nerve fibers of the sacral plexus - neuromodulation. AIM the review aim is to describe the technique and results of chronic sacral neurostimulation in treatment of pelvic organ disorders in children, which have been reported in the international literature. An obligatory condition for application of chronic sacral neurostimulation (CSNS) is a positive clinical response to test electrostimulation of the S3 nerve root. The test period duration is 1-3 weeks. In the case of a positive effect, a permanent system is implanted for neurostimulation of the S3 nerve root. On treatment with CSNS, children with severe urinary incontinence had a significant decrease in the rate of incontinence episodes, and patients with urinary retention had no or reduced need for periodic catheterization. Therefore, the accumulated experience of using CSNS in children with spinal cord diseases indicates the need in further study of the technique capabilities for correction of pelvic organ dysfunctions.
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Affiliation(s)
- A V Dekopov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Tomskiy
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - R V Salyukov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - Yu R Salyukova
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - O E Machevskaya
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - Sh U Kadyrov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
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Lu PL, Mousa HM. Neuromodulation for Gastrointestinal Dysmotility in Pediatric Patients. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Factors Predicting Complications After Sacral Neuromodulation in Children. Urology 2017; 107:214-217. [DOI: 10.1016/j.urology.2017.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/19/2022]
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16
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Averbeck MA, Gomes CM. Worldwide Utilization Patterns of Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0383-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Sacral Neuromodulation for Bladder Dysfunction in Children: Indications, Results and Complications. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Palmer LS. Evaluation and Targeted Therapy of Voiding Dysfunction in Children. Urology 2016; 92:87-94. [DOI: 10.1016/j.urology.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/12/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
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Schober MS, Ching CB, Peters KM, Alpert SA. Novel Use of Pudendal Neuromodulation in a Pediatric Patient With Caudal Regression and Partial Sacral Agenesis for Refractory Bowel Bladder Dysfunction. Urology 2016; 94:224-6. [PMID: 27034090 DOI: 10.1016/j.urology.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
Sacral neuromodulation (SNM) has been used off-label in the United States for over a decade in the pediatric population. Many published studies have demonstrated efficacy with SNM in this population; however, a significant number of children with refractory bowel bladder dysfunction (BBD) also have underlying comorbidities. Children with certain spinal abnormalities pose a problem for the urologist treating BBD. Patients with caudal regression can have various sacral anomalies, making SNM challenging or impossible. We present the first case in the United States of pudendal neuromodulation in a pediatric BBD patient with caudal regression.
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Affiliation(s)
- Megan S Schober
- Department of Urology, William Beaumont Hospital, Royal Oak, MI.
| | - Christina B Ching
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Seth A Alpert
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
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Mason MD, Stephany HA, Casella DP, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Prospective Evaluation of Sacral Neuromodulation in Children: Outcomes and Urodynamic Predictors of Success. J Urol 2016; 195:1239-44. [DOI: 10.1016/j.juro.2015.11.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew D. Mason
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Heidi A. Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Daniel P. Casella
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Douglass B. Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
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Truzzi JC, Gomes CM, Bezerra CA, Plata IM, Campos J, Garrido GL, Almeida FG, Averbeck MA, Fornari A, Salazar A, Dell’Oro A, Cintra C, Sacomani CAR, Tapia JP, Brambila E, Longo EM, Rocha FT, Coutinho F, Favre G, Garcia JA, Castaño J, Reyes M, Leyton RE, Ferreira RS, Duran S, López V, Reges R. Overactive bladder - 18 years - Part II. Int Braz J Urol 2016; 42:199-214. [PMID: 27176185 PMCID: PMC4871379 DOI: 10.1590/s1677-5538.ibju.2015.0367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022] Open
Abstract
Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.
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Affiliation(s)
- Jose Carlos Truzzi
- Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo, SP, Brasil
| | | | | | | | - Jose Campos
- Departamento de Urología, Escuela Médico Militar, Cidade do México, Mexico
| | - Gustavo Luis Garrido
- Cátedra de Urologia, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Fernando G. Almeida
- Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo, SP, Brasil
| | | | - Alexandre Fornari
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - Anibal Salazar
- Departamento de Urologia, AC Camargo Hospital, SP, Brasil
| | - Arturo Dell’Oro
- Hospital Clinico de la Fuerza Area de Chile, Santiago, Chile
| | - Caio Cintra
- Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasi
| | | | | | | | - Emilio Miguel Longo
- Servicio de Urología, del Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina
| | | | | | - Gabriel Favre
- Centro Policlínico Valencia “La Viña”, Valencia, Venezuela
| | | | | | - Miguel Reyes
- Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil
| | | | | | - Sergio Duran
- Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil
| | - Vanda López
- Servicio de Urología, del Hospital Universitario de Caracas, Caracas, Venezuela
| | - Ricardo Reges
- Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil
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Current Treatment Options for Nonneurogenic Overactive Bladder in Children. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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van der Wilt AA, van Wunnik BPW, Sturkenboom R, Han-Geurts IJ, Melenhorst J, Benninga MA, Baeten CGMI, Breukink SO. Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment. Int J Colorectal Dis 2016; 31:1459-66. [PMID: 27294660 PMCID: PMC4947479 DOI: 10.1007/s00384-016-2604-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Functional constipation in children and adolescents is a common and invalidating condition. In a minority of patients, symptoms persist despite optimal conservative therapy. The aim of this study was to evaluate whether the short-term effects of sacral neuromodulation (SNM) in children and adolescents with constipation are sustained over prolonged period of time. METHODS Patients aged 10-20 years, with refractory constipation, fulfilling the Rome III criteria, were included in our study. If SNM test treatment showed >50 % improvement in defecation frequency, a permanent stimulator was implanted. Primary outcome measure was defecation frequency during 3 weeks. Secondary endpoints were abdominal pain and Wexner score. To assess sustainability of treatment effect, a survival analysis was performed. Cross-sectional quality of life was assessed using the EQ-5D VAS score. RESULTS Thirty girls, mean age 16 (range 10-20), were included. The mean defecation frequency increased from 5.9 (SD 6.5) in 21 days at baseline to 17.4 (SD 11.6) after 3 weeks of test treatment (p < 0.001). During test treatment, abdominal pain and Wexner score decreased from 3.6 to 1.5 and 18.6 to 8.5 (p < 0.001), respectively. Improvement of symptoms sustained during a median follow-up of 22.1 months (12.2-36.8) in 42.9 % of patients. On a scale from 0 to 100, quality of life was 7 points lower than the norm score (mean 70 vs. 77). CONCLUSION SNM is a therapeutic option for children with chronic constipation not responding to intensive oral and/or laxative therapy, providing benefits that appear to be sustained over prolonged period of time.
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Affiliation(s)
- Aart A. van der Wilt
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Bart P. W. van Wunnik
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Rosel Sturkenboom
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Ingrid J. Han-Geurts
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Cor G. M. I. Baeten
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Stephanie O. Breukink
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
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Sacral Neuromodulation in Children. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Schober MS, Sulkowski JP, Lu PL, Minneci PC, Deans KJ, Teich S, Alpert SA. Sacral Nerve Stimulation for Pediatric Lower Urinary Tract Dysfunction: Development of a Standardized Pathway with Objective Urodynamic Outcomes. J Urol 2015; 194:1721-6. [DOI: 10.1016/j.juro.2015.06.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Megan S. Schober
- Section of Pediatric Urology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Jason P. Sulkowski
- Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children’s Hospital, Columbus, Ohio
| | - Peter L. Lu
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children’s Hospital, Columbus, Ohio
- Division of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, Ohio
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children’s Hospital, Columbus, Ohio
- Division of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, Ohio
| | - Steven Teich
- Division of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, Ohio
| | - Seth A. Alpert
- Section of Pediatric Urology, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Urology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Chang SJ, Van Laecke E, Bauer SB, von Gontard A, Bagli D, Bower WF, Renson C, Kawauchi A, Yang SSD. Treatment of daytime urinary incontinence: A standardization document from the International Children's Continence Society. Neurourol Urodyn 2015; 36:43-50. [DOI: 10.1002/nau.22911] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Shang-Jen Chang
- Division of Urology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Medical College of Buddhist Tzu; Chi University; Hualien Taiwan
| | - Erik Van Laecke
- Department of Urology; Section of Pediatric Urology; Ghent University; Ghent Belgium
| | - Stuart B. Bauer
- Department of Urology; Boston Children's Hospital; Harvard Medical School; Boston Massachusetts
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry; Saarland University Hospital; Germany
| | - Darius Bagli
- Division of Urology; Hospital for Sick Children and Department of Surgery; University of Toronto; Toronto Ontario
| | - Wendy F. Bower
- Department of Rehabilitation; The Royal Melbourne Hospital; Melbourne Australia
| | - Catherine Renson
- Department of Urology; Section of Pediatric Urology; Ghent University; Ghent Belgium
| | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Otsu Japan
| | - Stephen Shei-Dei Yang
- Division of Urology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Medical College of Buddhist Tzu; Chi University; Hualien Taiwan
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Sulkowski JP, Nacion KM, Deans KJ, Minneci PC, Levitt MA, Mousa HM, Alpert SA, Teich S. Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children. J Pediatr Surg 2015; 50:1644-7. [PMID: 25858097 DOI: 10.1016/j.jpedsurg.2015.03.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/07/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study describes our series of children with bowel and bladder dysfunction (BDD) treated with sacral nerve stimulation in order to begin to identify characteristics associated with better outcomes and guide future therapies. METHODS Between May 2012 and February 2014, 29 patients were evaluated before and after sacral nerve stimulator (SNS) placement. A prospective data registry was developed that contains clinical information and patient-reported measures: Fecal Incontinence Qualify of Life Scale, Fecal Incontinence Severity Scale, PedsQL Gastrointestinal Symptom Scale, and Vancouver DES Symptom Scale. RESULTS The median age of patients was 12.1 (interquartile range: 9.4, 14.3) years and the median follow-up period was 17.7 (12.9, 36.4) weeks. 93% had GI complaints and 65.5% had urinary symptoms while 7% had urologic symptoms only. The most common etiologies of BBD were idiopathic (66%) and imperforate anus (27%). Five patients required reoperation due to a complication with battery placement. Six of 11 patients (55%) with a pre-SNS cecostomy tube no longer require an antegrade bowel regimen as they now have voluntary bowel movements. Ten of eleven patients (91%) no longer require anticholinergic medications for bladder overactivity after receiving SNS. Significant improvements have been demonstrated in all four patient-reported instruments for the overall cohort. CONCLUSIONS Early results have demonstrated improvements in both GI and urinary function after SNS placement in pediatric patients with bowel and bladder dysfunction.
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Affiliation(s)
- Jason P Sulkowski
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Kristine M Nacion
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Hayat M Mousa
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Seth A Alpert
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH; Division of Pediatric Urology, Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Steven Teich
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH.
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Nadeau G, Schröder A, Moore K, Genois L, Lamontagne P, Hamel M, Pellerin E, Bolduc S. Double anticholinergic therapy for refractory neurogenic and nonneurogenic detrusor overactivity in children: Long-term results of a prospective open-label study. Can Urol Assoc J 2014; 8:175-80. [PMID: 25024786 DOI: 10.5489/cuaj.1362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin). METHODS This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients. RESULTS In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH2O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%). CONCLUSIONS With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.
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Affiliation(s)
- Geneviève Nadeau
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
| | | | - Katherine Moore
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
| | - Lucie Genois
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
| | - Pascale Lamontagne
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
| | - Micheline Hamel
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
| | - Eve Pellerin
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
| | - Stéphane Bolduc
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC
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Kieran K, Cooper CS. Role of Bladder Dysfunction in Vesicoureteral Reflux. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pediatric urinary incontinence: Classification, evaluation, and management. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2013.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Neuromodulation for Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2013; 8:282-288. [PMID: 30899337 DOI: 10.1007/s11884-013-0199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although neuromodulation is well established for the treatment of non-neurogenic lower urinary tract symptoms, recent literature supports its use in the patient having LUTS associated with a neurologic condition. Sacral neuromodulation, in particular, may see new use as a modality to facilitate neurologic remodeling in spinal cord injured patients as well as children. As a therapeutic option, sacral neuromodulation and dorsal genital nerve stimulation may one day become more effective and more efficient utilizing the concept of closed-loop feedback, where electro-neurogram and bladder pressure data are incorporated into stimulation routines. In addition, some older therapies are reviewed that have recently demonstrated success in this patient population.
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Stephany HA, Juliano TM, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Prospective Evaluation of Sacral Nerve Modulation in Children with Validated Questionnaires. J Urol 2013; 190:1516-22. [DOI: 10.1016/j.juro.2013.01.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Heidi A. Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Trisha M. Juliano
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B. Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Lippmann QK, Geller EJ. Successful Use of Sacral Neuromodulation in a 12-Year-Old With Cerebral Palsy and Neurogenic Bladder. Neuromodulation 2013; 17:396-8. [DOI: 10.1111/ner.12110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Quinn Kerr Lippmann
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
- Division of Female Pelvic Medicine and Reconstructive Surgery
| | - Elizabeth J. Geller
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
- Division of Female Pelvic Medicine and Reconstructive Surgery
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Lenis AT, Gill BC, Carmel ME, Rajki M, Moore CK, Vasavada SP, Goldman HB, Rackley RR. Patterns of Hardware Related Electrode Failures in Sacral Nerve Stimulation Devices. J Urol 2013; 190:175-9. [DOI: 10.1016/j.juro.2013.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Andrew T. Lenis
- Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bradley C. Gill
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Maude E. Carmel
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Maria Rajki
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Courtenay K. Moore
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sandip P. Vasavada
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Howard B. Goldman
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Raymond R. Rackley
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Dwyer ME, Reinberg YE. The Dysfunctional Elimination Syndrome in Children—Is Sacral Neuromodulation Worth the Trouble? J Urol 2012; 188:1076-7. [PMID: 22901582 DOI: 10.1016/j.juro.2012.07.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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This Month in Pediatric Urology. J Urol 2012. [DOI: 10.1016/j.juro.2012.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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