Ageing with sacral nerve modulation for fecal incontinence: how many patients get benefit after more than 10 years?

Abstract

Sacral nerve modulation (SNM) has represented a major advancement in the minimally invasive management of patients with fecal incontinence (FI). Although the success rate in the short–medium term has widely been demonstrated, the very long-term outcomes are poorly investigated. This study aims to assess the effectiveness of SNM in a cohort of patients with a follow-up longer than 10 years. Clinical records of patients submitted to SNM for FI in our tertiary referral colorectal Unit between 1998 and 2010 were retrospectively reviewed looking for status of the implantable pulse generator (IPG), follow-up duration, severity of FI by the St Marks’ score and quality of life. 58 patients fulfilled the entry criteria and 36 (58%, median follow-up, 12 years) accepted to take part to the telephone interview, while 22 (38%) were lost to the follow-up. Nineteen patients had their IPG removed (Group A) while 17 (27%) had the SNM still active after a median follow-up of 13 years (Group B). In the group A, the median baseline St Marks’ score was 13 and did not change after the IPG removal. In group B, the median baseline St Marks’ score was 14, at last IPG substitution, it was of 7 and at the last follow-up dropped to 4. In the group A, the median SF-12 physical and mental scores did not change significantly while they improved significantly in group B. A progressive deterioration of the success rate of SNM with the time has been documented after a very long-term follow-up.

The Long-term Outcomes of Sacral Neuromodulation for Fecal Incontinence: A Single-Center Experience

“…A previous study measuring the impact on QoL over time observed a sustained improvement in 42 patients at 5-year F/U with the FIQoL score, 24 whereas another demonstrated only a partial improvement in 2 domains of the Short Form 12 questionnaire at 10-year F/U. 22 These questionnaire-based results contrast with the sustained reduction in absolute FIE and FUE observed in both groups with active devices, highlighting the different measures contained in generic questionnaire assessments of treatment efficacy, which can overestimate or underestimate the impact on individual patients. 10,25,26 Therefore, these results should be interpreted in concert with bowel diary data and used to highlight patients who may be in need of further support or additional treatment strategies.…”

“…This is in contrast to previous reports that the efficacy may deteriorate after this time when only a limited number of outcome measures are used. 22 It has been suggested that patients may amplify symptom severity at baseline and understate severity during PNE to gain access to SNM treatment. 23 We did not find evidence of this in our study, with bowel diary measures at the last F/U demonstrating the improvements observed during PNE in those with active devices and a deterioration in those with inactive devices.…”

Autotransplante anorretal em suínos: padronização do modelo e avaliação pós- operatória em trinta dias

“…87,88 A necessidade do uso prolongado desses aparelhos associada a complicações acumuladas e diminuição da eficácia comprovada ao longo dos anos de uso tornam o tratamento com NMS extremamente caro e de baixa relação custo-benefício. [89][90][91] Além disso, não serve para IF grave com lesões musculares extensas e não tem utilidade quando ocorre perda ou ressecção completa do EA.…”