Long-Term Outcomes of Sacral Nerve Stimulation for Fecal Incontinence

George, Anil Thomas; Kalmár, Katalin; Panarese, Alessandra; Dudding, T. C.; Nicholls, R. J.; Vaizey, C. J.

doi:10.1097/dcr.0b013e3182401ecd

Cited by 71 publications

(43 citation statements)

References 20 publications

(19 reference statements)

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“…These suggest an improvement in symptoms can be achieved after 5 years and longer. However, there does appear to be some loss of efficacy over time [9,24]. It is not clear why this should be, or what the predictive factors are.…”

Section: Sacral Nerve Stimulationmentioning

confidence: 99%

“…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.…”

Section: The Prosthetic Anal Sphinctermentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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Advances in the Surgical Treatment of Faecal Incontinence

Thomas

Vaizey

2013

Curr Surg Rep

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Faecal incontinence is a common condition. Once conservative therapy has failed, surgical management of this problem is required. Over the last decade, neuromodulation has emerged as an effective and safe treatment. The most widely used form of neuromodulation is sacral nerve stimulation. The other less commonly used techniques are posterior tibial nerve stimulation and pudendal nerve stimulation. Anterior sphincteroplasty still has an important role to play in selected cases. If these treatments fail, then other therapies need to be considered. Recent advances in anal sphincter bulking agents and artificial sphincter devices offer some hope for these patients.

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Section: Sacral Nerve Stimulationmentioning

confidence: 99%

Section: The Prosthetic Anal Sphinctermentioning

confidence: 99%

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Advances in the Surgical Treatment of Faecal Incontinence

Thomas

Vaizey

2013

Curr Surg Rep

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“…This minimally invasive technique modulates nerve impulses to the S3 nerve root, and has been shown to be very effective at improving FI symptoms in patients who have failed conservative measures [7–11]. Since mainstream acceptance as a treatment option for FI, it is unclear which patients may most benefit from treatment with SNM and there is no consensus as to the required work-up for patients prior to proceeding with SNM.…”

Section: Introductionmentioning

confidence: 99%

Does preoperative anal physiology testing or ultrasonography predict clinical outcome with sacral neuromodulation for fecal incontinence?

et al. 2015

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Introduction and hypothesis To determine the value of preoperative anal physiology testing and transanal ultrasonography in predicting clinical response to sacral neuromodulation for fecal incontinence. Methods We report a retrospective study of all patients treated with sacral neuromodulation for fecal incontinence in a single practice between 2011 and 2014 was performed. Patient demographics included age, gender, comorbidities, presence of an ultrasound-defined external sphincter defect, and history of prior anal sphincter repair. Cleveland Clinic Florida (CCF) scores were used to assess the severity of fecal incontinence at baseline, and at 3, 6 and 12 months. Pearson's correlation coefficient was used to evaluate the relationship between preoperative physiology testing and ultrasonography and patient outcome. Results Sacral neuromodulation was trialed in 60 patients, of whom 31 had anorectal physiology testing and 29 did not. Patients who were tested were younger (60.9 vs. 71.4 years, p=0.013) and more likely to have had a prior overlapping sphincteroplasty (40.5 % vs. 15 %, p=0.043). Among patients who progressed to complete system implantation, CCF scores at 3 and 12 months were similar whether they had physiology testing or not. Likewise, patient outcome did not correlate with the finding of an ultrasound-defined external sphincter defect. Pearson's correlation coefficient was used to evaluate the relationship between the test results and the 3-month CCF scores. CCF scores 3 months after full system implantation did not correlate with the presence or size of an external sphincter defect, resting or squeeze pressure, pudendal nerve terminal motor latency, rectoanal inhibitory reflex, or minimum detectable volume. Conclusions Anal physiology testing and ultrasonography were not predictive of clinical outcomes among patients treated with sacral neuromodulation for fecal incontinence.

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“…This minimally invasive technique modulates nerve impulses to the S3 nerve root, and has been shown to be very effective at improving FI symptoms in patients who have failed conservative measures [7][8][9][10][11]. Since mainstream acceptance as a treatment option for FI, it is unclear which patients may most benefit from treatment with SNM and there is no consensus as to the required work-up for patients prior to proceeding with SNM.…”

Section: Introductionmentioning

confidence: 99%