Long-Term Outcomes of Sacral Nerve Stimulator Removal in Pediatric Bladder Dysfunction

Overview

This 13-year institutional cohort study evaluated sacral nerve modulation (SNM) explantation in pediatric patients with refractory bladder bowel dysfunction (BBD). Among 129 SNM implants, 36.4% were explanted, predominantly due to symptom resolution (72.3%), with a median device retention of 6 years. Post-explantation follow-up demonstrated sustained symptom relief in the majority of patients.

Background

Pediatric bladder bowel dysfunction encompasses a range of lower urinary tract symptoms that significantly impair quality of life and may lead to serious complications if untreated. Conventional therapies often fail in a subset of patients, prompting use of sacral nerve modulation (SNM) as a neuromodulatory treatment. While SNM shows promising short- and mid-term outcomes in children, data on long-term device retention and reasons for explantation remain limited. This study addresses these gaps by analyzing explantation trends and durability of symptom resolution over extended follow-up.

Data Highlights

Key Findings

• Out of 129 pediatric SNM implants, 36.4% underwent device explantation over a median follow-up of 3.5 years.
• Median time to explantation was 6 years, with 72.3% of explants due to symptom resolution (cure) and 27.7% due to complications.
• Complications leading to explantation included infections, pain, MRI requirements, and clinical ineffectiveness, with most complications occurring within 3 years post-implant.
• Competing risk analysis showed a significantly higher likelihood of explantation for cure versus complications (Gray’s test p = 0.001).
• Among patients explanted for cure, 94.4% of respondents maintained symptom resolution without medication at median 3.8 years post-explant.
• A small minority experienced symptom recurrence manageable with pharmacotherapy.

Clinical Implications

Sacral nerve modulation is a viable long-term treatment for refractory pediatric bladder bowel dysfunction, with a substantial proportion of patients achieving durable symptom resolution allowing device removal. Clinicians should monitor for early complications within the first three years post-implant. Post-explantation follow-up is important to identify and manage any symptom recurrence, which appears infrequent and often controllable with medication.

Conclusion

This extended follow-up study demonstrates that SNM explantation in pediatric patients is commonly due to sustained symptom resolution, with excellent long-term outcomes in most cases. These findings support SNM as an effective and potentially curative therapy for refractory pediatric bladder dysfunction.

References

1. Institutional Cohort Study 2024 -- Assessing the Probability of Sacral Nerve Stimulator Removal in Pediatric Patients