Editorial Comment

Abstract

The authors report interesting findings in their review of a very large series of children who underwent implantation of a sacral neuromodulator. Some of the important points to note are the limited success with this approach and the high complication rate. These factors, along with the expense and invasive nature of this therapeutic approach, require that its use be limited to a select population. The present study does not address how the severity of symptoms related to outcome, but future studies from this group or others should help to better define which select population is most likely to benefit from this technique based on a variety of predictive factors. The patients in this study were noted to be refractory to a variety of other therapies including urotherapy, biofeedback, medications, and, in some, botulinum toxin injection. Our group, as well as others, has reported success with neuromodulation in a similar group of children using surface patch electrodes (transcutaneous electrical nerve stimulation) or posterior tibial nerve stimulation. 1 Malm-Buatsi E. Nepple K.G. Boyt M.A. et al. Efficacy of transcutaneous electrical nerve stimulation in children with overactive bladder refractory to pharmacotherapy. Urology. 2007; 70: 980-983 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar , 2 De Gennaro M. Capitanucci M.L. Mosiello G. et al. Current state of nerve stimulation technique for lower urinary tract dysfunction in children. J Urol. 2011; 185: 1571-1577 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar A trial of these less-invasive forms of neuromodulation in children seems prudent before implanting a sacral neuromodulator given the limitations noted previously. Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A 10-Year Single-center Experience With 105 Consecutive ChildrenUrologyVol. 84Issue 4PreviewTo evaluate our initial experience using sacral neuromodulation via implanted pulse generator as a treatment for children with dysfunctional elimination syndrome and symptoms refractory to maximum medical therapy. Full-Text PDF ReplyUrologyVol. 84Issue 4PreviewWe agree with the important points that Dr Cooper has identified and with maximizing the available noninvasive and minimally invasive options before proceeding with sacral neuromodulation. We have been treating patients with posterior tibial nerve stimulation for a number of years with varying degrees of success. We do not require a trial of posterior tibial nerve stimulation before sacral neuromodulation because, for many patients, age- or family-related geographic, financial, and time constraints preclude this option. Full-Text PDF