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Sacral neuromodulation for continence problems in children: multicentric study

M. Haddad¹, D. Aubert², R. Besson³, P. Ravasse*, JL. Lemelle**, A. El Ghoneimi***, J. Moscovici****, F. Hameury*****, G. Hery¹, JM. Guys¹.

¹Hôpital d'Enfants de la Timone, Marseille;

²Hôpital Saint Jacques, Besançon;

³CHU Lille;

*CHU Caen;

**CHU Nancy;

***Hôpital Robert Debré, Paris;

****Hôpital des Enfants, Toulouse;

*****CHU Lyon.

 

ABSTRACT

Introduction: We present the definitive results of a prospective, randomized, crossed multicentric study to evaluate the therapeutic efficiency of sacral neuromodulation (SNM) in the approach of incontinence in neurologic bladders and intestinal dysfunctions in children (Hospital Clinical Research Programme 2006)

Material and methods: This study was aimed at children between 5 and 18 years presenting urinary incontinence associated or not with fecal incontinence secondary to a congenital anomaly. After confirming a response to the stimulation of the 3rd sacral root under general anesthesia, the patients underwent implant procedures (Interstim/ Medtronics). Each patient had 2 succesive therapeutic phases of 6 months: one under SNM, the other under conventional treatment (the patient being its own witness). A clinical examination, micturition and fecal calendars, an urodynamic and recto-manometric evaluation were made every 3 months.

Results: 33 patients (24 boys) of a mean age of 12.22 years were included in the study. The principal etiologies: spina bifida and sacral agenesis. The incontinence was mixed (urinary and fecal) in 19 patients, isolated urinary in 9 and isolated fecal in 5. The functional and total vesical capacities increased during the SNM (+27.86 and +31.86 vs. -41.05 and -31; p= 0.005 and p=0.04 respectively). There was no significant difference concerning the other urodynamic and rectomanometric parameters. Global clinical improvement (including successes) is superior to 70% for both types of incontinence. Meanwhile, the successes (complete disappearing of incontinence) are more numerous for fecal incontinence (32% vs. 8%). In the crossanalisys there is strong evidence that the SNM is clinically more effective than conservative treatment for each type of incontinence, p=0.002 (10 patients have the association “SNM=success, control=failure”, vs. 0 with “SNM=failure, control=success”).

Conclusions: Sacral neuromodulation has a beneficial effect on the urinary bladder an on intestinal dysfunction and should be discussed in our therapeutic arsenal against incontinence.

 

Key words: sacral neuromodulation, prospective, randomized, crossed multicentric study