Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder.  while Bladder dysfunction and constipation are common in pediatrics. Sacral neuromodulation (SNM) is a minimal invasive therapy for lower urinary tract symptoms. It is a promising option  in children for both  constipation, urine  and fecal incontinence .The aim of our research is to study sacral neuromodulation effectiveness in pediatric age group in Saudi Arabia.

A prospective cohort study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia from April 2017 till Jan 2020 .We included pediatric patients with normal upper tract and diagnosed to have urine incontinence , fecal incontinence,  high PVR and using intermittent catheterization (CIC) to empty bladder and patients who are refractory to the maximum medical treatment ,or discontinued therapy because of side effects. Candidate child’s parents are counselled in the clinic for sacral neuromodulation , technique, risks and benefits. The procedure was done in two phases under General anesthesia.  All cases were done by same single surgeon using standard technique .

Total Candidates’ parents counselled in clinic were 105.
Parents acceptance rate were 37.1%  39/105.
 Only 39 pediatrics underwent phase one procedure. 
Successful phase one was in 29 with Implantation rate 74% (29/39).
 Patients age were from 8 to 16 years .
Diagnosis: spinal bifida 8, Posterior urethral valve 2, Hinman’s syndrome 18, fecal incontinence 1
urodynamic baseline showed  Overactive bladder  in 22  patients, atonic bladder in 6 
Patients post implantation become urine continent in 60% ( 18/28)
Fecal continence rate was 66% (6/9)
Medications were discontinued in 50% ( 15/29) . 
Intermittent catheterization was stopped in 40% ( 12/28)
 Complications : electrode migration in 1 patient, loss of efficacy in 1, and 2 device explanation for normalized nerve function after device is turned off for 1 year

Sacral neuromodulation showed safety and effectiveness in selected pediatric patients.  

Parents acceptability of therapy is low as a newly introduced off label therapy and need cooperative , highly educated parents . 

The reported normalized nerve function suggests early treatment with neuromodulation may lead to  resolution of symptoms which will need more studies.

Sacral neuromodulation is approved for the treatment of bladder and bowel dysfunction in adults

Children suffer from both neurogenic and non-neurogenic voiding dysfunction and my benefit from SNM

Early treatment with neuromodulation  in pediatrics may lead to resolution of symptoms due to neuroplasticity .

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 Feb;17(1):72.e1-72.e7. doi: 10.1016/j.jpurol.2020.10.010. Epub 2020 Oct 16. PMID: 33129672.
Casal Beloy I, García-Novoa MA, García González M, Somoza Argibay I. Update on sacral neuromodulation and overactive bladder in pediatrics: A systematic review. Arch Esp Urol. 2021 Sep;74(7):699-708. English, Spanish. PMID: 34472439.
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