261 / 492
08:21 - 08:24
S21-3
(PP)
★
SUBJECTIVE AND OBJECTIVE OUTCOMES OF SACRAL NEUROMODULATION IN
CHILDREN WITH REFRACTORY LOWER URINARY TRACT DYSFUNCTION AND
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Megan SCHOBER and Seth ALPERT
Nationwide Children's Hospital, Urology, Columbus, USA
PURPOSE
Children with attention deficit hyperactivity disorder (ADHD) have significantly higher rates of lower urinary tract
dysfunction (LUTD). These children have decreased success rates of LUTD treatment compared to non-ADHD
children. Our aim is to measure subjective and objective outcomes of sacral neuromodulation (SNS) in children with
refractory LUTD and ADHD.
MATERIAL AND METHODS
Eight children diagnosed with ADHD underwent placement of a sacral nerve stimulator for refractory LUTD and were
followed prospectively. Our protocol approach includes pre- and post-operative NLUTD/DES questionnaires, urodynamic
testing, and spinal MRI. Inclusion criteria was failure of two or more anti-cholinergics, behavioral modification,
biofeedback, and/or percutaneous tibial nerve stimulation.
RESULTS
All patients had symptoms of daytime incontinence, enuresis, and urinary frequency pre-operatively. The overall
NLUTD/DES symptom score trended toward significance with a pre-operative mean score of 21.88 compared to 14.13
post-operatively (p=0.06). Urinary incontinence (pre- mean 3.25, post- mean 1.38; p=0.017) and urinary frequency
voiding scores (pre- mean 2.875, post- mean 1.875; p=0.05) did improve significantly post-operatively. One child had
complete resolution of enuresis (12.5%). Three children (37.5%) stopped anticholinergic medications without symptom
recurrence. There was no statistically significant improvement in number of uninhibited contractions or maximum
detrusor pressure during filling phase on urodynamics.
CONCLUSIONS
Children with ADHD and LUTD pose a significant treatment problem for pediatric urologists. We present a cohort of
ADHD patients with refractory LUTD treated with SNS. We demonstrate significant symptom improvement in daytime
incontinence and urinary frequency. SNS is a treatment option that should be considered to treat refractory LUTD in
children with ADHD.