Evaluating the likelihood of pediatric sacral nerve stimulator explantations due to cure or complications: a survival analysis of 13-year institutional cohort

Abstract

Introduction: Sacral neuromodulation (SNM) is a treatment option for children with refractory bladder and bowel dysfunction. Prior investigations have shown children may achieve cure of their symptoms following SNM implants and subsequently have their devices explanted. Herein, we present a 13-year experience of pediatric SNM placements and evaluate the likelihood of SNM explantation for any cause, for symptom resolution or complications. Methods: An institutional retrospective review of children who underwent a 2nd stage SNM placement between November 2012 and January 2025 was performed. Reasons for SNM explantation was categorized as a cure or complication. Competing-risk time-to-event analysis was used. Results: There were 129 SNM placements at a median of 10 years old (IQR 8.1-12.7); 88 were females (68.2%) and 41 required SNM revision (31.8%). Median follow-up was 3.5 (IQR 2.0-5.3) years. Subsequently, 46 underwent SNM explantation (35.7%). On survival analysis, median time to explantation (50%) was 6.0 (IQR 4.6-7.3) years. Among explanted, 34 were due to symptom resolution (73.9%) and 13 due to complications (4 infections; 4 pain at site; 3 for MRI requirements; 1 clinically ineffective). On competing risks analysis, 72.5% of the explantations at 6 years were for cure and 27.5% for complications. The 6-year explantation risk was 36.3% for cure and 13.8% for complications. Among 17 children who provided data after device explanation following cure (response rate: 51.5%), 16 (94%) had sustained symptom resolution at a median of 3.8 years (IQR 1.3-5.3) after explantation. Conclusion: Approximately quarter of children with SNM placement achieved cure with increasing probability with follow-up time. More than 70% of explantations are due to cure and less than 10% were due to infections. There is high likelihood of sustained symptom resolution following explantation for cure. SNM remains a safe and viable option for children with refractory BBD with potential for cure.