Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence

Tan, Ek Khoon; Ngo, Nye Thane; Darzi, Ara; Shenouda, Michael; Tekkis, Paris

doi:10.1007/s00384-010-1119-y

Cited by 82 publications

(52 citation statements)

References 69 publications

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“…A recent meta-analysis of 34 studies further supports their findings [87]. Patients with SNS had decreased weekly FI and incontinence scores, demonstrated increased ability to defer defecation and demonstrated improved quality-of-life scores when compared with conservative therapies [87].…”

Section: Sacral Nerve Stimulationmentioning

confidence: 81%

Review of organic causes of fecal incontinence in children: evaluation and treatment

Ambartsumyan

Nurko

2013

Expert Review of Gastroenterology & Hepatology

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Even though fecal incontinence (FI) in children is most commonly the result of functional constipation, there are organic conditions that can be associated with incontinence. FI has a major impact on the quality of life of those children who experience it. The general objectives of any bowel program are to achieve predictability and independence. This is achieved by manipulating colonic transit and stool consistency and by producing more controlled evacuations, usually with the use of rectal interventions. Dietary interventions and medications can be used to change stool consistency or to manipulate transit by accelerating or slowing it down. Biofeedback or other interventions that increase sphincter pressure can also be used to improve anorectal function. Enemas or suppositories can be used to empty the sigmoid colon in a more controlled manner. With the recent advent of the antegrade colonic enemas, the patient can have predictable bowel movements and become independent.

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Section: Sacral Nerve Stimulationmentioning

confidence: 81%

Review of organic causes of fecal incontinence in children: evaluation and treatment

Ambartsumyan

Nurko

2013

Expert Review of Gastroenterology & Hepatology

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“…Improvement in weekly FI episodes and FI scores was significantly greater in patients with intact versus impaired sphincters, but those with impaired sphincters experienced a greater increase in the ability to defer defecation. However, the complication rate among the 665 patients who had permanent SNS electrode implantation was ∼15%, resulting in permanent removal of the device in 18 (2.7%) patients 67. A multicenter, prospective nonrandomized trial, not included as part of the previous meta-analysis, reported that 83% of 106 patients had ≥50% improvement in FI at 12 months and 40% became fully continent 62.…”

Section: Resultsmentioning

confidence: 99%

Current and Emerging Treatment Options for Fecal Incontinence

Rao

2014

Journal of Clinical Gastroenterology

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Fecal incontinence (FI) is a multifactorial disorder that imposes considerable social and economic burdens. The aim of this article is to provide an overview of current and emerging treatment options for FI. A MEDLINE search was conducted for English-language articles related to FI prevalence, etiology, diagnosis, and treatment published from January 1, 1990 through June 1, 2013. The search was extended to unpublished trials on ClinicalTrials.gov and relevant publications cited in included articles. Conservative approaches, including dietary modifications, medications, muscle-strengthening exercises, and biofeedback, have been shown to provide short-term benefits. Transcutaneous electrical stimulation was considered ineffective in a randomized clinical trial. Unlike initial studies, sacral nerve stimulation has shown reasonable short-term effectiveness and some complications. Dynamic graciloplasty and artificial sphincter and bowel devices lack randomized controlled trials and have shown inconsistent results and high rates of explantation. Of injectable bulking agents, dextranomer microspheres in non-animal stabilized hyaluronic acid (NASHA Dx) has shown significant improvement in incontinence scores and frequency of incontinence episodes, with generally mild adverse effects. For the treatment of FI, conservative measures and biofeedback therapy are modestly effective. When conservative therapies are ineffective, invasive procedures, including sacral nerve stimulation, may be considered, but they are associated with complications and lack randomized, controlled trials. Bulking agents may be an appropriate alternative therapy to consider before more aggressive therapies in patients who fail conservative therapies.

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“…In comparison with SNS, the more commonly used alternative neuromodulation technique, PTNS is expected to be less expensive (SNS £15,000/patient vs PTNS £1000/patient, equipment cost alone), but the true cost-effectiveness of PTNS still needs to be ascertained in a prospective randomized study. [15][16][17] The standardized unit protocol allows PTNS therapy to be offered to patients with FI who have not responded to conservative measures, including biofeedback. As per the protocol, we do not offer PTNS therapy to women who are pregnant, to patients with a diagnosis of peripheral neuropathy or coagulopathy associated with excessive bleeding, or to patients with cardiac problems, especially in the presence of a pacemaker or defibrillator.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Tibial Nerve Stimulation for Fecal Incontinence

Hotouras

Allison²,

Currie³

et al. 2012

Diseases of the Colon &Amp; Rectum

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Percutaneous tibial nerve stimulation is a technically simple procedure that can potentially be performed in an outpatient or community setting. The overall early success rate of 68% following its use reported by our unit compares favorably with the success rate following other forms of neuromodulation, including sacral nerve stimulation. When completed, our long-term outcome data will provide further information on the efficacy of tibial nerve stimulation in a larger cohort of patients (n > 100). Future studies, including our currently planned randomized controlled trial of percutaneous tibial nerve stimulation vs sham stimulation, will provide controlled efficacy data and may provide information on its exact mechanism of action.

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Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence

Abstract: SNS results in significant improvements in objective and subjective measures for faecally incontinent patients.

Cited by 82 publications

References 69 publications

Review of organic causes of fecal incontinence in children: evaluation and treatment

Review of organic causes of fecal incontinence in children: evaluation and treatment

Current and Emerging Treatment Options for Fecal Incontinence

Percutaneous Tibial Nerve Stimulation for Fecal Incontinence

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