Podium Session 2: Functional Urology, Pediatric Urology

Introduction: As the prevalence of refractory bladder and bowel dysfunction (BBD) persists, innovative solutions are paramount in pediatric urologic care.This study aimed to present the inaugural Canadian experience using sacral neuromodulation (SNM) as a therapeutic option for children with refractory BBD.Methods: Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present.Preoperative evaluation included spinal MRI and video urodynamics.Refractory BBD was defined by symptom persistence after six months of conservative and >3 months of optimized combined medical therapy.Two-stage SNM implantation was executed with a minimum two-week stage-1 trial.Functional outcomes and complication rates were measured following institutional protocols.Results: Six patients completed stage-2 implantation at a median age of 10.8 (range 8.2-18) years.Indications included one patient with primary bladder symptoms (urinary incontinence [UI]), four with mixed dysfunction-UI, fecal incontinence (FI), and one FI (Table 1).The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10-22).Medication use was reduced; at six-month followup, only one patient required adjunct bladder medication.Median DVSS at one-year followup was 5.5 (0-7).Symptomatic resolution was noted in three patients at six months, sustained over one year.Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring SNM reimplantation at a median of 37.5 (range 36-49) months post-implantation.Conclusions: SNM offers promising results for refractory pediatric BBD in Canada.The significant improvement in symptoms highlights the treatment's potential, which must be balanced against the high need for revision detected at three years.This study establishes the feasibility of introducing SNM for selected refractory pediatric patients with BBD.