Kim Jin Kyu, Szymanski Konrad M, Misseri Rosalia, King Shelly J, Batra Nikhil V, Kaefer Martin, Cain Mark P, Rink Richard C, Roth Joshua, Dangle Pankaj, Meldrum Kirstan, Whittam Benjamin M
Department of Urology, Riley Hospital for Children, 702 Barnhill Drive, Indianapolis, IN, 46202, USA.
World J Urol. 2025 Aug 28;43(1):519. doi: 10.1007/s00345-025-05916-7.
Sacral neuromodulation (SNM) is a treatment option for children with refractory bladder and bowel dysfunction. Prior investigations have shown children may achieve cure of their symptoms following SNM implants and subsequently have their devices explanted. Herein, we present a 13-year experience of pediatric SNM placements and evaluate the likelihood of SNM explantation for any cause, for symptom resolution or complications.
An institutional retrospective review of children who underwent a 2nd stage SNM placement between November 2012 and January 2025 was performed. Reasons for SNM explantation was categorized as a cure or complication. Competing-risk time-to-event analysis was used.
There were 129 SNM placements at a median of 10 years old (IQR 8.1-12.7); 88 were females (68.2%) and 41 required SNM revision (31.8%). Median follow-up was 3.5 (IQR 2.0-5.3) years. Subsequently, 46 underwent SNM explantation (35.7%). On survival analysis, median time to explantation (50%) was 6.0 (IQR 4.6-7.3) years. Among explanted, 34 were due to symptom resolution (73.9%) and 13 due to complications (4 infections; 4 pain at site; 3 for MRI requirements; 1 clinically ineffective). On competing risks analysis, 72.5% of the explantations at 6 years were for cure and 27.5% for complications. The 6-year explantation risk was 36.3% for cure and 13.8% for complications. Among 17 children who provided data after device explanation following cure (response rate: 51.5%), 16 (94%) had sustained symptom resolution at a median of 3.8 years (IQR 1.3-5.3) after explantation.
Approximately quarter of children with SNM placement achieved cure with increasing probability with follow-up time. More than 70% of explantations are due to cure and less than 10% were due to infections. There is high likelihood of sustained symptom resolution following explantation for cure. SNM remains a safe and viable option for children with refractory BBD with potential for cure.
骶神经调节（SNM）是治疗难治性膀胱和肠道功能障碍儿童的一种选择。先前的研究表明，儿童在植入SNM后可能症状得到治愈，随后移除装置。在此，我们介绍了13年的儿科SNM植入经验，并评估因任何原因、症状缓解或并发症而移除SNM的可能性。
对2012年11月至2025年1月期间接受二期SNM植入的儿童进行机构回顾性研究。SNM移除的原因分为治愈或并发症。采用竞争风险事件发生时间分析。
共进行了129次SNM植入，中位年龄为10岁（四分位间距8.1 - 12.7）；88例为女性（68.2%），41例需要SNM翻修（31.8%）。中位随访时间为3.5年（四分位间距2.0 - 5.3）。随后，46例进行了SNM移除（35.7%）。生存分析显示，移除的中位时间（50%）为6.0年（四分位间距4.6 - 7.3）。在移除的病例中，34例是由于症状缓解（73.9%），13例是由于并发症（4例感染；4例局部疼痛；3例因MRI需求；1例临床无效）。竞争风险分析显示，6年时72.5%的移除是由于治愈，27.5%是由于并发症。6年时因治愈的移除风险为36.3%，因并发症的移除风险为13.8%。在17例治愈后移除装置后提供数据的儿童中（应答率：51.5%），16例（94%）在移除后中位3.8年（四分位间距1.3 - 5.3）症状持续缓解。
约四分之一接受SNM植入的儿童随着随访时间的增加治愈概率上升。超过70%的移除是由于治愈，不到10%是由于感染。因治愈而移除后症状持续缓解的可能性很高。SNM仍然是难治性膀胱肠道功能障碍儿童的一种安全可行的选择，有治愈的潜力。
