Sacral Neuromodulation and Repetitive Magnetic Stimulation : Applications in Pediatric Surgery

The bladder and rectoanal function is strongly influenced by the sacral neural system. Spinal cord injuries, gynecological and obstetric procedures, and operations of the prostate and anorectum may often induce voiding and/or bowel dysfunction. Recently, chronic electrical stimulation of the sacral nerve has been used to treat such disorders refractory to ordinary medical treatments. As an alternative method of electrical stimulation through implanted electrodes, a noninvasive technique of the repetitive magnetic stimulation has been used with favorable results. In the field of pediatric surgery, there are a variety of diseases where interaction between the anorectum and sacral neural system might be disturbed, especially in Hirschsprung' disease, anorectal malformations, and chronic constipation in childhood. However, such abnormalities have not been clearly elucidated. We have therefore started such a study by looking at the rectoanal manometric responses to repetitive magnetic stimulation of the sacral roots. This review summarizes the history of the electrical pacing of the bladder function via spinal and sacral neural stimulation which has led to the notion of sacral neuromodulation. We herein will briefly introduce our findings in a currently on-going study and discuss the future prospects of this technique.