Noninvasive Sacral Neuromodulation in Children and Adolescents: A Case-Control Study of Patients With Chronic Refractory Constipation

Sonja Diez; Annemarie Kirchgatter; Dana Adam; Arne Füldner; Hanna Müller; Klaus E Matzel; Manuel Besendörfer

doi:10.1016/j.neurom.2022.08.451

Noninvasive Sacral Neuromodulation in Children and Adolescents: A Case-Control Study of Patients With Chronic Refractory Constipation

Neuromodulation. 2023 Dec;26(8):1858-1866. doi: 10.1016/j.neurom.2022.08.451. Epub 2022 Oct 4.

Authors

Sonja Diez¹, Annemarie Kirchgatter², Dana Adam², Arne Füldner², Hanna Müller³, Klaus E Matzel⁴, Manuel Besendörfer²

Affiliations

¹ Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. Electronic address: sonja.diez@uk-erlangen.de.
² Department of Surgery, Section of Pediatric Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
³ Department of Pediatrics, Neonatology and Pediatric Intensive Care, University of Marburg, Marburg, Germany.
⁴ Department of Surgery, Section of Coloproctology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

PMID: 36207226
DOI: 10.1016/j.neurom.2022.08.451

Abstract

Objectives: In adult patients with chronic refractory constipation, invasive sacral neuromodulation (SNM) has been applied successfully. There is a need for less invasive solutions while providing comparable therapeutic effects in children and adolescents. We present a prospective, interventional case-control study on the application of noninvasive SNM.

Materials and methods: Patients with chronic constipation refractory to conservative treatment were prospectively included in the study from 2018 to 2021 and randomized to either SNM (SNM group: single current stimulation for 24 h/d, frequency 15 Hz, pulse width 210 μs, intensity 1-10 mA) or conventional treatment (controls: full range of pharmacologic and nonpharmacologic options). Treatment was conducted for 12 weeks. Treatment effects were collected with specialized questionnaires and quality-of-life analysis (KINDL_R). Outcome variables were defecation frequency, stool consistency, fecal incontinence (FI) episodes, and abdominal pain.

Results: Analysis was conducted in 28 patients with SNM and 31 controls (median age 7.0, range 3-16 years). Overall responsiveness to treatment was 86% of the SNM group and 39% of the control group (p < 0.001). All outcome variables were positively influenced by SNM treatment. Defecation frequency improved in 46% of patients with SNM and in 19% of controls (p = 0.026), as did stool consistency in 57% of patients with SNM and in 26% of controls (p = 0.014). Fecal incontinence was significantly reduced in 76% of patients with SNM (n = 16/21 vs 42% of controls [n = 11/26], p = 0.042). Quality of life improved significantly during SNM treatment (71.32 [baseline] vs 85.00 [after 12 weeks], p < 0.001) and confirmed a positive influence of SNM treatment compared with the control group (85.00 [SNM after 12 weeks] vs 79.29 [controls after 12 weeks], p = 0.047).

Conclusions: Outcome of noninvasive SNM treatment in patients with chronic refractory constipation is better than conventional treatment.

Keywords: Fecal incontinence; Hirschsprung disease; functional constipation; sacral nerve stimulation; sacral neuromodulation.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Case-Control Studies
Child
Child, Preschool
Constipation / therapy
Electric Stimulation Therapy* / adverse effects
Fecal Incontinence* / etiology
Fecal Incontinence* / therapy
Humans
Lumbosacral Plexus
Prospective Studies
Quality of Life
Treatment Outcome