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S21-11
(P)
PAEDIATRIC SACRAL NERVE STIMULATION; THE SOUTHAMPTON EXPERIENCE.
Judith DOCKRAY, Kerry WILKINSON and Henrik STEINBRECHER
University Hospitals Southampton, Paediatric Urology, Southampton, UNITED KINGDOM
PURPOSE
Sacral Nerve Stimulation (SNS) is an established modality for the treatment of lower urinary tract symptoms in adults,
particularly related to overactive bladder (OAB). Its use in children is being slowly established, though evidence is
largely based around single-centre experiential studies on children with mixed urinary and faecal symptoms.
MATERIAL AND METHODS
We present our 4 year, prospectively collected, experience of the SNS use, for a series of 9 children aged 7-15 with
urodynamically proven detrusor overactivity. 7/9 of the group were female and 2/9 male. 7/9 patients had a diagnosis
of idiopathic detrusor overactivity and 2/9 had neuropathic detrusor overactivity. All patients had failed medical
treatment with at least 2 anticholinergics and desmopressin. All had tried Transcutaneous Electrical Nerve Stimulation
(TENS) and intravesical botulinum toxin injection as second and third-line treatment.
RESULTS
9 patients had temporary test wires inserted. 6/9 patients experienced a "good" response, classed as significant (≥50%)
improvement of symptoms or complete cure. They went on to permanent box insertion. 2/6 patients required revision
surgery in the form of minor wire adjustments. 1 patient requested removal of her system due to lack of response.
Of the 3/9 who did not respond to the test wire. 1/9 was cured on wire removal, 1/9 progressed to augmentation and
1/9 continued on medical therapy.
CONCLUSIONS
Our data confirms a success rate consistent with the literature available for adult and mixed symptom
paediatric groups. It is one of the larger series specifically looking the application in paediatric urinary
incontinence.
The data is limited by the lack of sensible validated questionnaires, the vast differences in expectations and
issues with compliance that make urinary incontinence such a challenging problem in this age group. The
high success rate, combined with low side-effect and complication profile make this an attractive alternative
before augmentation is considered.