MP50-19 SACRAL NEUROMODULATION IN BLADDER AND BOWEL DYSFUNCTION: EARLY INSIGHTS FROM THE FIRST CANADIAN PEDIATRIC COHORT
Bibliographic record
Abstract
You have accessJournal of UrologyPediatrics III (MP50)1 May 2024MP50-19 SACRAL NEUROMODULATION IN BLADDER AND BOWEL DYSFUNCTION: EARLY INSIGHTS FROM THE FIRST CANADIAN PEDIATRIC COHORT Dean Elterman, Roseanne Ferreira, Natasha Brownrigg, Mandy Rickard, Max Freeman, Abby Varghese, Michael Chua, Armando Lorenzo, and Joana Dos Santos Dean EltermanDean Elterman , Roseanne FerreiraRoseanne Ferreira , Natasha BrownriggNatasha Brownrigg , Mandy RickardMandy Rickard , Max FreemanMax Freeman , Abby VargheseAbby Varghese , Michael ChuaMichael Chua , Armando LorenzoArmando Lorenzo , and Joana Dos SantosJoana Dos Santos View All Author Informationhttps://doi.org/10.1097/01.JU.0001008684.57262.97.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As the prevalence of refractory bladder and bowel disease (BBD) persists, innovative solutions are paramount in pediatric urological care.This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM) as therapeutic option for children with refractory BBD. METHODS: Patients<18 years-old with refractory BBD were prospectively followed from 2018 to present. Preoperative evaluation included spinal MRI and videourodynamics. Refractory BBD was defined by symptom persistence after 6 months of conservative and >3 months of optimized combined medical therapy. Two-stage SNM implantation was executed with a minimum 2-week Stage-1 trial. Functional outcomes and complication rates were measured following institutional protocols. RESULTS: Six patients completed Stage-2 implantation at median age of 10.8 years (range 8.2-18). Indications included one patient with primary bladder symptoms – urinary incontinence (UI) -, four mixed dysfunction - UI, Fecal incontinence (FI) and one FI (Table 1). Median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10-22). Medication utilization reduced; At 6 months follow-up, only one patient required adjunct bladder medication. Median DVSS at 1-year follow-up was 5.5 (0-7). Symptomatic resolution was noted in 3 patients at 6 months, sustained over 1-year. Early surgical complications were reported in 1 (infection) and late complications in 3 (lead fracture, battery depletion, non-traumatic malfunction), requiring SNM reimplantation at a median of 37.5 months (range 36-49) post-implantation. CONCLUSIONS: SNM offers promising results for refractory pediatric BBD in Canada. The significant improvement in symptoms highlights the treatment's potential which must be balanced against the high need for revision detected at 3 years. This study establishes the feasibility of introducing SNM for selected refractory pediatric patients with BBD. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e839 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dean Elterman More articles by this author Roseanne Ferreira More articles by this author Natasha Brownrigg More articles by this author Mandy Rickard More articles by this author Max Freeman More articles by this author Abby Varghese More articles by this author Michael Chua More articles by this author Armando Lorenzo More articles by this author Joana Dos Santos More articles by this author Expand All Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".