First experiences with pudendal nerve stimulation in fecal incontinence: a technical report

Abstract

Sacral nerve stimulation (SNS) is an established treatment for refractory lower urinary tract and bowel dysfunction. In some urological patients, SNS does not have satisfactory results. Pudendal nerve stimulation (PNS) has recently been proposed for these patients and successfully tested. Given the sometimes unsatisfactory results after SNS in fecal incontinence (FI), we tested PNS on patients suffering from FI. We used the device and implantation technique described by Spinelli et al. By making a slight change in the device, we developed a quick and easy-to-use method for successful PNS implantation, based on electrophysiological response. We present the results of a feasibility study, in which we tested the effectiveness of PNS with our modified implantation technique on 2 patients, with very satisfactory early results in a 4-month follow-up.

Fecal Incontinence: Etiology, Diagnosis, and Management

“…While it has been studied in the treatment of neurogenic bladder disorders, there are currently no large-scale studies examining its utility for fecal incontinence. 54 In 2012, the LINX esophageal reflux management system, a ring of titanium beads with a magnetic core, was introduced for the treatment of GERD and found to be efficacious and improve patients' quality of life. While the natural inclination is to apply the same concept for fecal incontinence, studies are limited to pilot series, and the method has yet to gain FDA approval.…”

Die Zukunft der invasiven Neuromodulation

“…Bereits in den 1960er Jahren wurden an Menschen operative Techniken zur Reinnervation des unteren Harntrakts erprobt [3]. Die Arbeitsgruppe um Xiao [30] …”

Advances in the Surgical Treatment of Faecal Incontinence

“…At a median follow up of 59 (30-72) months, ten of these patients became continent. The Cleveland Clinic Florida-FI score improved from 16 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) at baseline to 3 (0-7). Two of these devices were explanted due to infection following revisional surgery.…”

“…At present, only a few reports have described PNS as a treatment for FI. The first was a two patient case series in 2010 [10]. In 2011 George et al [39] reported its use in seven patients who had had a poor response to SNS.…”

“…The majority of the recent literature addressing the management of FI has focussed on neuromodulation. Sacral nerve stimulation (SNS) [6][7][8][9] is the most studied modality; the use of other more peripheral nerves including the pudendal [10,11] and posterior tibial nerves is now being investigated [12].…”