Sacral Neuromodulation Enables Spontaneous Voiding in Adolescent with Neurogenic Bladder

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“She is finally able to urinate normally,” her mother shared during a recent follow-up visit after sacral neuromodulation (SNM) at Beijing Children’s Hospital, Capital Medical University. The 15-year-old adolescent, who had relied on diapers and clean intermittent catheterization for years due to neurogenic bladder, now demonstrates stable urinary function without residual urine or leakage nearly one year after implantation.

The patient was diagnosed in infancy with an intraspinal lipoma and underwent surgical resection at one year of age. Although the lesion was surgically removed, bladder dysfunction persisted, leading to significant post-void residual urine, recurrent urinary tract infections, urgency, and leakage during physical activity. Clean intermittent catheterization was required six to seven times daily, and prolonged diaper use imposed substantial physical and psychosocial burden on both the patient and her family.

Neurogenic bladder refers to lower urinary tract dysfunction caused by neurological impairment affecting bladder storage and voiding control. Clinical manifestations may include urinary retention, frequency, urgency, incontinence, constipation, and, in severe cases, renal failure.

After years of ongoing urinary dysfunction requiring long-term catheterization and diaper use, with continued impact on her schooling and psychological well-being, the family sought further evaluation at the Functional Neurosurgery Department. Following comprehensive assessment—including urinalysis, voiding cystourethrography, ultrasonography with residual urine measurement, urodynamic testing, and imaging studies—and multidisciplinary discussion, she was determined to be an appropriate candidate for sacral neuromodulation.

SNM delivers low-frequency electrical stimulation to the sacral nerves regulating lower urinary tract and pelvic floor function. An approximately 21-mm electrode is implanted at the S3 sacral foramen, where continuous stimulation modulates dysfunctional reflex pathways—functioning much like a neuromodulatory pacemaker—and restores coordinated detrusor–sphincter activity.

SNM is performed in two stages: temporary electrode implantation followed by a 2–4 week testing phase, with permanent implantation proceeding if urinary symptoms improve by more than 50% and satisfactory benefit is observed.

Stage I implantation was performed on January 24, 2025. Before the procedure, she had almost no spontaneous voiding and experienced pronounced urgency and leakage. During the testing period, stimulation parameters were carefully adjusted. By the fourth postoperative week, spontaneous voided volume reached approximately 1,300 mL per day. Urgency and leakage resolved, and residual volume during intermittent catheterization decreased to only several dozen milliliters.

Permanent implantation was completed on March 7, 2025.

At follow-up on July 31, 2025, urodynamic testing confirmed effective bladder emptying without residual urine, urgency, or leakage. The patient discontinued diaper use—ending more than a decade of dependence—and resumed regular school and daily activities. At one-year follow-up, urinary function remains stable, and both the patient and her family report satisfaction with the outcome.

Recognizing the long-term burden associated with neurogenic bladder and bowel dysfunction, the Functional Neurosurgery Department has incorporated sacral neuromodulation into its newly approved clinical technology program. The department has since completed multiple SNM procedures for pediatric patients with refractory bladder and defecation disorders, broadening therapeutic options prior to irreversible interventions such as bladder augmentation.

The department noted that SNM may be considered for selected pediatric patients with overactive bladder, non-obstructive urinary retention, neurogenic lower urinary tract dysfunction, bladder–bowel dysfunction, refractory constipation, and fecal incontinence who do not respond to conservative therapy.

Functional Neurosurgery Department