Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence

Abstract

IntroductionFaecal incontinence (FI) is a common condition with a significant impact on quality of life (QoL). Neuromodulation treatments delivered by members of the multidisciplinary team including sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS) are options for FI refractory to conservative management. The aim of this study was to assess whether a successful treatment with one neuromodulation modality corresponds with success in the other.MethodsA retrospective review of a prospectively managed neuromodulation database identified 15 patients who had undergone both PTNS and SNS. The definition of success of each treatment was a >50% improvement in any of The St. Mark's Incontinence Score, Manchester Health Questionnaire, or weekly faecal urgency or FI episodes.ResultsComplete data from 12 patients was available for assessment and PTNS was delivered as the first treatment in nine patients. Overall, seven patients (58%) had successful PTNS treatment, with 10 (83%) having a successful SNS trials. Of the seven patients who had successful PTNS treatment, six patients (85.4%) went on to have success with SNS. Of the five patients who failed PTNS, four (80%) went on to have SNS success. Five (71%) of those who had positive PTNS outcomes had permanent SNS implantation as their final treatment decision.ConclusionThis study suggests that there is no clear relationship between successful PTNS treatment and an SNS trial period which may be explained by differing mechanisms of action or the potential placebo effect of PTNS. Further work is required to investigate any association in larger studies to inform clinical practice.

Short-term clinical and manometric outcomes of percutaneous tibial nerve stimulation for faecal incontinence: a large single-centre series

“…Sacral neuromodulation (SNM) is now the first-line surgical intervention for FI with demonstrable short and long-term efficacy [ 4 , 5 ]; however, it requires two surgical procedures, and carries a high upfront financial cost. By contrast, percutaneous tibial nerve stimulation (PTNS) is an outpatient, minimally invasive therapy involving stimulation of the tibial nerve at the ankle [ 6 ], which may be used as a treatment option before SNM [ 7 ]. Given the shared sacral nerve root origin of the pudendal nerve and posterior tibial nerve, it is believed stimulation of the latter could lead to the improvement in FI symptoms reported with SNM [ 8 ].…”