Prospective Randomized Double-Blind Study of Temporary Sacral Nerve Stimulation in Patients With Rectal Evacuatory Dysfunction and Rectal Hyposensitivity

Knowles, Charles H.; Thin, Noel N.; Gill, Katherine; Bhan, Chetan; Grimmer, Karyn; Lunniss, Peter J.; Williams, Norman S.; Scott, S. M.

doi:10.1097/sla.0b013e318247d49f

Cited by 97 publications

(94 citation statements)

References 48 publications

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“…By contrast, in a prospective, 18-week randomized, double-blind, placebo-controlled, two-phase crossover study, neither sub- nor supra-sensory SNS increased the proportion of complete bowel movements compared to sham SNS in 55 patients with medically-refractory slow transit constipation and normal anorectal functions evaluated with manometry, rectal balloon expulsion, and proctography 69 . Hence, although small studies suggest that SNS may improve rectal sensation in patients with DD and rectal hyposensitivity 70 and induce colonic propagating sequences 71 , there is no evidence that SNS improves bowel symptoms or rectal evacuation in defecatory disorders.…”

Section: Sacral Nerve Stimulation (Sns) For Defecatory Disordersmentioning

confidence: 99%

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

Bharucha

Rao

Shin

2017

Clinical Gastroenterology and Hepatology

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Description The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. Methods The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best practice advice 1 A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first. Best practice advice 2 Pelvic floor retraining with biofeedback therapy is recommended for patients with FI who do not respond to the conservative measures indicated above. Best practice advice 3 Perianal bulking agents such as intraanal injection of dextranomer may be considered when conservative measures and biofeedback therapy fail. Best practice advice 4 Sacral nerve stimulation should be considered for patients with moderate or severe FI in whom symptoms have not responded after a 3 month or longer trial of conservative measures and biofeedback therapy and who do not have contraindications to these procedures. Best practice advice 5 Until further evidence is available, percutaneous tibial nerve stimulation should not be used for managing FI in clinical practice. Best practice advice 6 Barrier devices should be offered to patients who have failed conservative or surgical therapy, or in those who have failed conservative therapy who do not want or are not eligible for more invasive interventions. Best practice advice 7 Anal sphincter repair (sphincteroplasty) should be considered in postpartum women with FI and in patients with recent sphincter injuries. In patients who present later with symptoms of FI unresponsive to conservative and biofeedback therapy and evidence of sphincter damage, sphincteroplasty may be considered when perianal bulking injection and sacral nerve stimulation are not available or have proven unsuccessful. Best practice advice 8 The artificial anal sphincter, dynamic graciloplasty, may be considered for patients with medically-refractory severe FI who have failed treatment or are not candidates for barrier devices, sacral nerve stimulation, perianal bulking injection, sphincteroplasty and a colostomy. Best practice advice 9 Major anatomic defects (e.g., rectovaginal fistula, full thickness rectal prolapse, fistula in ano, or cloacalike deformity) should be rectified with surgery. Best practice advice 10 A colostomy should be considered in patients with severe FI who have failed conservative treatment and have failed or are not candidates for barrier devices, minimally invasive surgical interventions, and sphincteroplasty. Best practice advice 11 A magnetic anal sphincter device may be considered for patients with medically refractory severe FI who have failed o...

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Section: Sacral Nerve Stimulation (Sns) For Defecatory Disordersmentioning

confidence: 99%

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

Bharucha

Rao

Shin

2017

Clinical Gastroenterology and Hepatology

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“…These changes were not evident when the stimulator was turned off. Eleven patients progressed to permanent stimulation (9/11 success at 19 months) [25]. Additional, long-term controlled trials with assessment of subjective and objective features are necessary to clarify the role of electrical stimulation in both constipation and DD.…”

Section: Defecatory Disordersmentioning

confidence: 99%

Management of Pelvic Floor Disorders: Biofeedback and More

Prichard

Bharucha

2014

Curr Treat Options Gastro

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“…Gerade bei Patienten mit kombinierter proktologischer und urologischer Symptomatik sind funktionell hervorragende Resultate zu erreichen. In den letzten Jahren wird die SNS auch bei chronischer Obstipation zunehmend erfolgreich eingesetzt [62][63][64][65] Zudem hat die Einführung der STARR-Operation mit dem ContourTranstar-Gerät bei gleichwertigen funktionellen Ergebnissen nicht zu erhöhten Komplikationsraten geführt [32][33][34]38]. Eine definitive Bewertung dieses Verfahrens bzw.…”

Section: Sakrale Neuromodulation: Ein Neuer Weg Beim Obstruktiven Defunclassified

Indikationen und chirurgische Therapieoptionen beim obstruktiven Defäkationssyndrom

Schwandner¹

2012

Viszeralmedizin

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Hintergrund: Das obstruktive Defäkationssyndrom (ODS) beschreibt einen Symptomkomplex, der sowohl funktionelle als auch morphologisch-anatomische Störungen beinhaltet, die einen großen Einfluss auf die Lebensqualität haben. Wenn konservative Therapiekonzepte ausgeschöpft sind, können chirurgische Therapieoptionen erörtert werden. Methoden: Indikationen und chirurgische Therapieoptionen beim ODS wurden anhand der publizierten Literatur und der persönlichen Verfahrenswahl analysiert und bewertet. Ergebnisse: Die adäquate Behandlung des ODS bleibt aufgrund der vielfältigen Ursachen und Ausprägungsformen generell eine Herausforderung – dies gilt für konservative Behandlungsoptionen in gleicher Weise wie für operative Therapiekonzepte. Diagnostik und Therapie der symptomatischen Rektozele und des inneren Rektumprolapses (Intussuszeption) bleiben kontrovers. Bei den Operationsverfahren konkurrieren transabdominelle Rektopexieverfahren mit transanalen Operationsmethoden (STARR-Operation). Die Bedeutung der sakralen Neuromodulation beim ODS kann aufgrund fehlender Langzeitergebnisse noch nicht bewertet werden. Schlussfolgerungen: Patientenselektion, Indikationsstellung und auch die Art der chirurgischen Maßnahme stellen eine Herausforderung beim ODS dar, sodass hier eine generelle Zurückhaltung bei der Operationsindikation zu fordern ist. Dies gilt für alle chirurgischen Therapieoptionen und betrifft somit transabdominelle, transperineale und transanale Verfahren.

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Prospective Randomized Double-Blind Study of Temporary Sacral Nerve Stimulation in Patients With Rectal Evacuatory Dysfunction and Rectal Hyposensitivity

Abstract: Most patients with chronic constipation secondary to ED with rectal hyposensitivity responded to temporary SNS. The physiological results presented support a mechanistic role for rectal afferent modulation.

Cited by 97 publications

References 48 publications

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders

Management of Pelvic Floor Disorders: Biofeedback and More

Indikationen und chirurgische Therapieoptionen beim obstruktiven Defäkationssyndrom

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