What is the role of surgery in the treatment of overactive bladder (OAB) in children?

Updated: Apr 01, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Although neuromodulation is used more commonly in adults, this treatment approach has been used in children in whom behavioral and pharmacologic therapy fails. The exact mechanism by which neuromodulation affects detrusor overactivity is not fully understood. Sacral nerve stimulation may induce reflex-mediated inhibitory effects on the detrusor through afferent and/or efferent stimulation of the sacral nerves. In addition, stimulation of the somatic fibers of the nerves may activate the pelvic floor muscles, causing further detrusor inhibition. [45]

The procedure requires surgery; thus, many parents are reluctant to proceed. In addition, the current version of the device is relatively large for a child, so this procedure may be more attractive to parents when a smaller device becomes available.

Transcutaneous stimulation has been used in children. This involves placement of surface electrodes to stimulate the sacral root (S3). Several stimulation frequencies have been used, and stimulation of 2 Hz seems to be sufficient. Researchers have not yet determined the optimal length of each stimulation during a treatment session nor how many sessions the treatment should continue. [46, 47, 48]

Surgical procedures such as bladder augmentation or autoaugmentation are rarely needed in children with idiopathic OAB but may be indicated in children with neurogenic OAB refractory to medical therapy.


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