EARLY EXPERIENCE WITH SACRAL NEUROMODULATION IN CHILDREN WITH FECAL INCONTINENCE
Raymond F. Roewe, Jr., M.D., Elizabeth Roth, M.D., Ruth Swedler, M.S., Heidi Vanderpool, APNP, Katja Kovacic, M.D., Manu Sood, M.D., Travis Groth, M.D., John Kryger, M.D., Hrair-George Mesrobian, M.D..
Children's Hospital of Wisconsin, Milwaukee, WI, USA.
INTRODUCTION: The FDA has approved the use of sacral nerve stimulation (SNS) for the treatment of urinary, and, more recently, fecal incontinence (FI) in adults. Over the last 10 years, several studies have reported similar effectiveness in pediatric patients with medical refractory urinary incontinence (UI). However, data regarding its viability in children with FI is sparse. We present our experience with SNS in pediatric patients with medical refractory FI.
METHODS: We retrospectively reviewed the electronic medical records of 10 children who underwent SNS implantation for medical refractory FI. After work-up to exclude anatomic or neurologic abnormalities, SNS implantation was performed in a staged approach which included permanent lead placement in the third sacral foramen connected to an external stimulator. Patients with > 50% symptom improvement after the first stage underwent subsequent permanent placement of the generator.
RESULTS: Eight patients (80%) who underwent Stage I placement qualified for permanent placement of an internal generator. Five patients underwent SNS primarily for fecal incontinence, and 5 for mixed fecal and urinary incontinence. Median age at placement was 10.7 years (7.6 - 15.5 years), and median follow-up was 7.38 months (2.8 - 12.1 months). Seven (87.5%) patients who underwent Stage II internalization showed complete resolution of fecal incontinence at follow-up. All patients had a negative work-up for neurologic causes for urinary and/or fecal incontinence. The original gastrointestinal symptoms included two patients with dyssynergia, four with a lack of high amplitude contractions in the left colon, and one each with no contractions and low resting anal pressure. Two children underwent cecostomy reversal. There was one superficial wound infection.
CONCLUSIONS: SNS appears to be a viable treatment option for the management of medically refractory fecal incontinence in the pediatric population. Our experience is consistent with what has been published in the adult literature, and has encouraged us to undertake a prospective study evaluating quality of life in this population.
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