Pediatric Overactive Bladder and the Role of Sacral Neuromodulation

Purpose of Review: Overactive bladder is the most common cause of voiding dysfunction in the pediatric population. Bladder overactivity can be challenging to address often requiring “trial and error” and a multimodal treatment plan. The purpose of this manuscript is to summarize the role and efficacy of sacral neuromodulation in the treatment of pediatric bladder overactivity. Recent Findings: The exact mechanism of action of sacral neuromodulation is poorly understood. Sacral neuromodulation likely has a multifactorial effect on the voiding pathway acting on both the peripheral and central nervous system per functional MRI studies. Modulation of a child’s developing neural pathways has shown to have durable effects with improvements persisting after the device has been deactivated and/or explanted. Summary: Pediatric bladder overactivity should be treated in step-wise fashion, starting with the least invasive therapy. Sacral neuromodulation should be considered only in refractory cases. Sacral neuromodulation is effective in decreasing, and may completely resolve bothersome lower urinary tract symptoms. These improvements in bladder symptoms translate into improvements in a child’s and caregiver’s quality of life. In appropriately selected patients, sacral neuromodulation is a succesful long-term treatment for overactive bladder. © 2022, The Author(s), under exclusive licence to Springer Nature Switzerland AG.