Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection

Background: Sacral nerve modulation (SNM) is a minimally invasive treatment for chronic constipation or incontinence when conservative treatment is insufficient to provide relieve of symptoms. Case description: A 74-year-old patient with an implanted sacral nerve lead is presented in this case report with a dislodged lead without an adverse change in her incontinence treatment. This phenomenon has never been described before and raises the debate on sacral lead positioning in sacral nerve stimulation. Discussion: There are a lot of conflicting data regarding ideal lead positioning, such as S3 versus S2 or S4 implantation. The lead position in our case doesn't correspond to previously described locations and pathways which corroborate the legitimacy of new developments in this area such as percutaneous tibial nerve stimulation, transcutaneous tibial nerve stimulation and transcutaneous abdominal electrical stimulation (TEN). Conclusions: The implantation of SNM seems standardized but leaves voids in the technique where further research is needed to refine it.

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“…[13] Hence when unilateral percutaneous nerve stimulation fails, a bilateral test can be contemplated. [14,15] …”

Section: Bilateral Versus Unilateral Stimulationmentioning

confidence: 99%

Successful sacral nerve modulation despite migration of tined lead

Dekkers

Schmitz

Heyden

et al. 2016

CSS

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“…The efficacy of sacral neuromodulation in partial sphincter injury has also been demonstrated (35)(36)(37). In patients with scleroderma having proctitis caused by radiation and reduced rectal compliance owing to inflammatory bowel syndrome and in patients with anterior resection or previous rectal prolapse colectomy, the efficacy of sacral neuromodulation is demonstrated only in few studies (38)(39)(40)(41)(42)(43).…”

Section: Gastrointestinal Disordersmentioning

confidence: 99%

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

Ozyalcin¹

2015

Turk J Phys Med Rehab

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The aim of this article is to determine the effectiveness and the safety of sacral nerve stimulation on the several indications. Sacral nerve stimulation as a neuromodulation technique, is an effective and increasingly used therapeutic option. As a minimally invasive technique, many advances in the techniques for sacral neuromodulation have been described. The well-known indication of sacral nerve stimulation is the urinary voiding dysfunction. Although the mechanism of neuromodulation is still unclear, multipl new indications have been identified, include faecal incontinence, constipation, pain sydromes, interstitial cystitis, mixt urinary and bowel disoders, spinal injury and neurodegenerative disease, and sexual dysfunction. Since there is lack of high quality evidence of the procedure at present, good quality prospective, cross-over and randomize controlled studies are required to determine the true benefits of sacral nerve stimulation.

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“…Esta clasificación, que no llegó a utilizarse, fue el primer intento de evaluar la importancia de la repercusión que la IA tenía sobre la vida cotidiana. En 1993, Jorge y Wexner 20 proponen un sistema de puntuación (de 0 a 20) para evaluar la gravedad de la IA que incluye una pregunta sobre la frecuencia en que los episodios de IA alteran el estilo de vida (tabla II); dada su sencillez, este cuestionario, conocido como escala de Wexner, ha sido ampliamente utilizado [34][35][36][37][38] . Una puntuación de 9 o más en esta escala se asocia con una baja puntuación del índice de calidad de vida gastrointestinal (menor de 105) 34 , o sea, el confinamiento domiciliario y poca actividad social.…”

Section: Calidad De Vida En Pacientes Con Incontinencia Analunclassified