Abstract General Information

Title

Posterior Tibial Nerve Stimulation for Non-Traditional Indications in Pediatric Patients

Introduction and objective

Neuromodulation is recommended for adults with lower urinary tract symptoms (LUTS) refractory to conservative treatment. However, its role for pediatric patients with refractory LUTS is less well defined and little is known about use of neuromodulation for pediatric patients with LUTS secondary to causes other than non-neurogenic overactive bladder (OAB). We reviewed our experience with posterior tibial nerve stimulation (PTNS) in pediatric patients for bothersome LUTS not related to OAB (“non-traditional” indications).

Method

We have prospectively followed all patients treated with PTNS at our institution since 4/2022. Criteria were persistent LUTS despite urotherapy and trial of at least one antimuscarinic or beta-3 agonist. For this analysis we included patients with indications for PTNS other than OAB including those with neurogenic bladder (NB) who completed >12 sessions. Induction of PTNS was 12 weekly 30-minute sessions in the office. After induction, patients may continue every other week for 6 months then monthly for up to 2 years. All patients fill out weekly questionnaires (DVISS, pediatric incontinence quality of life [PinQ]).

Results

3 patients were in our “non-traditional” PTNS group. Patient 1: 17yo male with functional neurologic symptom disorder, urinary retention, urgency and incontinence managed with CIC. After PTNS voiding improved with lower CIC volumes and improved DVISS (13 to 2) and PinQ (33 to 3) scores. Patient 2: 9yo male with NB secondary to tethered cord managed with CIC. After PTNS dry interval improved with increased bladder sensation, DVISS (13 to 7) and PinQ (17 to 14) improved. Patient 3: 17yo female with history of vesicoureteral reflux and bilateral ureteral reimplant with urinary retention requiring CIC. Since PTNS her voided volumes improved with decreased CIC volumes, and she is now dry between CIC. DVISS (7 to 4) and PinQ (17 to 1) scores improved.

Conclusion

Our results suggest that even pediatric patients with non-traditional indications for PTNS including urinary retention may see an objective and subjective improvement with treatment. As this is a small cohort, further research is needed to confirm and better understand these results.