Sacral Nerve Stimulation in Fecal Incontinence

Rasmussen, Ole F.; Buntzen, Steen; Sörensen, M. Bredgaard; Laurberg, Søren; Christiansen, John

doi:10.1007/s10350-004-0553-8

Cited by 76 publications

(56 citation statements)

References 17 publications

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“…The precise pathophysiological mechanism why the procedure is effective is unknown, and this may be seen in the medical literature for a variety of anorectal manometry values, both pre-and post-operatively, where various irreproducible effects are described for all series: increased maximum tolerated volume, increased volume at which sensation takes place, and increased sphincter resting pressure (18)(19)(20)(21). In our study, following the procedure we saw that voluntary contraction pressure improved in a statistically significant manner.…”

Section: Discussionmentioning

confidence: 56%

Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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Objective: to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation.Patients: fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed.Results: mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean followup is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode.Conclusions: sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate.Key words: Fecal incontinence. Anal sphincter. Anorectal manometry. INTRODUCTIONSacral nerve stimulation in the management of fecal incontinence has led to a change in the diagnostic and therapeutic algorithm for this disease in recent years (1-5). This treatment modality so far removed from the common practice of general surgeons has forced coloproctology specialists to undergo specific education on the technique's theoretical and practical aspects in order to treat their patients.The procedure's absolute indication in fecal incontinence was initially focused on incontinent patients showing integrity of the sphincteric apparatus because of no previous lesions (idiopathic incontinence) or because of a prior sphincteroplaty procedure losing efficacy over time (incontinence most often resulting from obstetric trauma or prior surgery). Its indication has been gradually extended to patients with sphincteric defects (6-10), hence there is an ever increasing number of incontinent patients that are eligible for this procedure, also including stimulators indicated for constipation (11) and pain (12). As with all surgical skills, neuromodulation also displays a learning curve that may be shortened with workshops on stimulators and cadaveric training but cannot be obviated. The goal of this study was to analyze the first fifty cases by three general surgeon teams who used sacral root stimulations for the management of fecal incontinence, and to review the procedure's difficulties and short-term outcomes and complications. MATERIAL AND METHODSThe first fifty patients with fecal incontinence treated with sacral nerve stimulation in four Madrid sites from 2004 to 2009 are retrospectively reviewed. All patients are adults (older t...

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Section: Discussionmentioning

confidence: 56%

Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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“…Sacral nerve stimulation was first used in patients with urinary bladder dysfunction [13] and later, on with a high success rate, in patients with faecal incontinence [14][15][16]. The minimally invasive two-step procedure of sacral nerve stimulation with percutaneous nerve evaluation, together with placement of the percutaneous lead, was performed at our institution without any complications.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with conventional test electrode had a median Wexner score of 13.5 (range, [8][9][10][11][12][13][14][15][16] and those with tined lead 15 (range, 6-20); p=0.553. All patients received single dose antibiotics preoperatively (1000 mg cefazolin and 500 mg metronidazole intravenously).…”

Section: Methodsmentioning

confidence: 99%

New screening technique for sacral nerve stimulation under local anaesthesia

et al. 2005

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performed at the same time under local anaesthesia. The use of the new tined lead electrode significantly increased the success rate for the screening phase. Key words Faecal incontinence• Sacral nerve stimulation • Minimally invasive sacral neuromodulation • Tined lead electrode IntroductionSacral nerve stimulation (SNS) is an amazing therapy option for patients with urinary and bowel dysfunction [1][2][3][4][5][6]. The procedure involves three stages. The first step is a percutaneous nerve evaluation with a foramen needle. If a contraction of the pelvic floor can be observed, the second step consists of introducing a test electrode and an external pulse generator for a screening phase of 10-14 days. In patients with a positive response (symptoms decrease of more than 50% measured by a continence diary), the third step replaces the test electrode with a permanent electrode, and a definitive implantation of the "internal pulse generator" (IPG) can be performed [1,7].However, the technique of SNS for the treatment of faecal incontinence is not standardised yet. Due to a high migration rate of test electrodes and due to the invasiveness of open implantation of the permanent system [8], Spinelli et al. [9], and the manufacture of the stimulator (Medtronic, Minneapolis, USA) recently developed a transcutaneous electrode (tined lead electrode) and a minimally invasive introducing kit. The new transcutaneous system is designed as a permanent electrode and can be used for both screening and permanent stimulation. It is supposed to improve the success rate of screening by decreasing the risk of electrode migration. In addition, implantation of the new tined lead electrode can be performed under local anaesthesia. Thereafter, the patient can feel and localise the stimulation Abstract BackgroundThe purpose of this study was to assess the influence of the type of anaesthesia (local vs. general) and of the electrode used (test electrode vs. tined lead) on a successful screening period. Methods Between May 2001 and January 2004, we performed 25 percutaneous nerve evaluation (PNE) tests in 20 patients (11 women). The first 15 PNE tests were followed by introducing a conventional electrode, and since 2003 by a tined lead electrode. Success was defined as reduction of symptoms by more than 50%. Results A stimulator was implanted in 13 (68%) patients, including 4 of 14 screened with the conventional electrode and 9 of 10 screened with tined lead electrode (p=0.005). Eleven (44%) of the PNE tests were done under local anaesthesia, but the success rate was not influenced by the type of anaesthesia (local 46% vs. general 61%, p=0.682). Conclusions PNE testing and implantation of the tined lead electrode can be easily Tech Coloproctol (2005) 9:25-28

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“…Rasmussen et al 17 , comunican una tasa de complicaciones durante el test de estimulación cercana al 20%, con un 6% de infecciones y cerca de un 14% de problemas relacionados con el electrodo.…”

Section: Fase De Evaluación Periféricaunclassified

“…Este alto índice, probablemente, refleja en parte, la curva de aprendizaje. Rasmussen et al 17 , reportan una tasa de infección del 5%. En el multicéntrico francés 24 , la tasa descrita, es muy inferior, 1,5%, misma cifra comunicada por Michelsen et al 21 .…”

Section: Fase De Implantación Del Generador Definitivounclassified

Complicaciones durante la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal grave

Arroyo

et al. 2013

Rev Chil Cir

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Complications during sacral nerve stimulation in the treatment of severe fecal incontinence Objective: To evaluate the complications of sacral nerve stimulation for the treatment of fecal incontinence. Background: Sacral nerve stimulation is considered to be nowadays an effective treatment for fecal incontinence in selected patients. Many authors have reported excellent results and indication for his use have increased. Nevertheless, even being a simple technique, not it exempts this from complications. Methods: Fifty-two patients with severe faecal incontinence, treated with sacral nerve stimulation between January 2002 and December 2010, were analysed. All adverse events during follow-up were recorded. Results: There was not surgical complication during peripheral neural evaluation test. In our series, with an average follow-up to 55.52 ± 31.84 months (range: 12-121), we had a rate of adverse effects of 14%, infection of surgical wound in two patients, break of electrode in two patients and the presence of pain in the place of the implant, with episodes of extremity pain and paresthesias in low members in 3 patients. Conclusions: Sacral nerve stimulation in severe fecal incontinence is a safe treatment, with a low index of complications.Key words: Sacral nerve stimulation, fecal incontinence, complications, adverse effects. ResumenObjetivo: Evaluar las complicaciones de la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal. Introducción: La neuromodulación de raíces sacras ha sido descrita como un tratamiento quirúrgico eficaz en pacientes con incontinencia fecal grave. Muchos autores han comunicado excelentes resultados y las indicaciones en su uso han aumentado. Sin embargo, a pesar de ser una técnica quirúrgica sencilla, no está exenta de complicaciones. Material y Método: 52 pacientes con incontinencia fecal grave, tratados mediante neuromodulación de raíces sacras entre enero de 2002 y diciembre de 2010, fueron anali-

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Sacral Nerve Stimulation in Fecal Incontinence

Abstract: Sacral nerve stimulation in fecal incontinence shows promising results. Patients with idiopathic, spinal etiology, or persisting incontinence after sphincter repair may benefit from this minimally invasive treatment.

Cited by 76 publications

References 17 publications

Sacral nerve stimulation for fecal incontinence

Sacral nerve stimulation for fecal incontinence

New screening technique for sacral nerve stimulation under local anaesthesia

Complicaciones durante la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal grave

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