Sacral Nerve Stimulation and the Pediatric Population

Presented at our March 12th meeting by Pam Hollatz, RN, Pediatric Surgical Associates and Brady Olson, Medtronic. Reviewed and article written by Staci Johnson, MS, APRN, CNS, CNOR

Objectives for this presentation:

  1. Identify when sacral nerve stimulation is used in the pediatric population
  2. Identify sacral nerve stimulation therapy and what does InterStim do?

Up to 20% of children experience pediatric dysfunctional elimination syndrome. Urologic or gastrointestinal manifestations may occur. Children experience urologic incontinence, frequency or urgency and urinary tract infections. Gastrointestinal symptoms include “clenching,” constipation and fecal incontinence.

Patients with pediatric dysfunctional elimination syndrome are treated with behavioral modification techniques, such as timed voiding and timed stooling, diet modification, biofeedback therapy, pharmacotherapy and maintain voiding diaries. These strategies succeed for 90% of pediatric patients. For the 10% who remain symptomatic, there is hope with InterStim.

The sacral nerves supply the bladder/pelvic floor area. For these patients, the nerves are not working in a manner that provides normal elimination function. InterStim works for patients who can’t urinate, or suffer constipation, and also works for patients who have overactive elimination, leaks and accidents. InterStim provides electrical pulse via a lead to a nerve. The patient can control the amplitude of the pulse. Nursing staff works with patients to determine their optimal level.

The InterStim provides a “reset” of the nerve pathway that allows the patient to experience control over bladder and bowel function that can be life changing for patients. InterStim is approved for patients 16 years and older. It is approved for urinary and fecal incontinence, and thus can be used for treating symptoms in pediatric patients. Insurance plans often dictate a two-step process. The patient receives a lead placed and tunneled externally for a trial stimulation. Patients feel a sensation in their pelvic area. A 50% improvement in symptoms is required for insurance approval to move on to stage 2 for permanent implantation.

Pre-op education and post-op follow up are key components to successful results with InterStim. Educational information and the surgical procedure can be viewed via a video that can be accessed from the Medtronic InterStim website.

This practice has treated pediatric patients who have experienced improvement in symptoms with subsequent removal of InterStim. For pediatric patients where incontinence and elimination problems have negatively impacted their life and activities, treatment with InterStim has allowed them to fully enjoy life. Adult patients can live with InterStim indefinitely; battery life is 4-5 years. Revisions are sometimes necessary.