Sacral Nerve Stimulation in Fecal Incontinence: Are There Factors Associated with Success?

Gourcerol, Guillaume; Gallas, Syrine; Michot, F; Denis, Philippe; Leroi, Anne‐Marie

doi:10.1007/s10350-006-0746-4

Cited by 92 publications

(85 citation statements)

References 23 publications

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“…[14][15][16] Double incontinence represents a much more severe and stressful condition of pelvic floor dysfunction. 17 This explains why these patients always attained a marked statistical improvement in four domains of the SF-36 following permanent SNM.…”

Section: Discussionmentioning

confidence: 99%

Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury

et al. 2011

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Objectives: To assess the concomitant clinical improvement in incomplete spinal cord injury patients (SCIPs) suffering from neurogenic bowel symptoms (NBSs), neurogenic lower urinary tract symptoms (NLUTSs) and neurogenic erectile dysfunction (NED) using sacral neuromodulation (SNM) for NBSs and NLUTSs. Methods: Seventy-five SCIPs were selected. Before and during the follow-ups post-SNM, NLUTSs and NBSs were detected mainly through specific diaries. Erectile function was assessed using the International Index of Erectile Function composed of 5 questions (IIEF5). Quality of life (QoL) was measured with the Short Form 36 Health Survey questionnaire (SF-36). During the first stage, in which a permanent electrode was inserted percutaneously into the third sacral foramina and stimulated using an external generator, patients with NBSs or NLUTSs were required to improve their symptoms by at least 50% compared with baseline before proceeding to the second stage in which the generator was placed in the patient's buttock. NED patients needed to increase their IIEF5 score by at least 25% compared with baseline (evaluated initially 3 months after the second stage) in order to continue follow-up. Results: Fourteen out of 37 subjects who manifested two functional pelvic dysfunctions at baseline maintained notable clinical improvement in two pelvic functions (median follow-up 43 years). Six had non-obstructive retention (NOR) and NED, six double incontinence, and two constipation with NOR. In the general and mental health domains of the SF-36, all patients improved their scores by at least 20% compared with baseline. Conclusions: SNM may be beneficial to selected incomplete SCIP with concomitant pelvic functional disturbances.

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Section: Discussionmentioning

confidence: 99%

Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury

et al. 2011

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“…12 For SNS, the implication of a peripheral neuropathy does not seem to predict failure of the technique. Gourcerol et al 13 found that a neurogenic cause of incontinence and abnormal sacral reflex testing was associated with a higher success of SNS. In our series, patients with an abnormal PNTML had no significant difference in their continence score at any time period up to 48 months compared with those who had normal PNTML.…”

Section: Discussionmentioning

confidence: 99%

Sacral Nerve Neuromodulation Is Effective Treatment for Fecal Incontinence in the Presence of a Sphincter Defect, Pudendal Neuropathy, or Previous Sphincter Repair

Brouwer

Duthie²

2010

Diseases of the Colon &Amp; Rectum

107

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“…16 Long-term clinical benefits and an increase in the number of responders would lead to a cost reduction in SNM therapy; indeed, in the long term, costs are likely to be comparable with those of conservative, sanitary and stoma therapies, even if comparative health costing in this area is difficult to determine because of the many factors that need to be taken into account. 17 A recent outcome and cost analysis of SNM for fecal incontinence has shown that it is highly effective.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions

et al. 2009

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Study design: Retrospective study. Objectives: Efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord-injured patients (SCIPs) affected by chronic neurogenic bowel symptoms (NBSs). Setting: Neurourology Department. Primary to tertiary care. Methods: Retrospective non-blinded study without controls. Thirty-nine SCIPs were submitted to temporary stimulation for NBS. Permanent implantation was carried out if both their NBSs improved and the Wexner questionnaire scores were reduced by at least 50% during the first stage compared with that at baseline. Outcome measures included episodes of fecal incontinence and number of evacuations per week, as well as the Wexner score and the Short Form 36 (SF-36) Health Survey questionnaire. Results: Twenty-three SCIPs were submitted to definitive SNM, maintaining their clinical benefits after permanent implantation with a median follow-up of 38 months. The length of time since neurological diagnosis to SNM therapy represents the only factor related to the success of the implantation, Po0.05. In subjects with constipation (12), the median number of evacuations shifted from 1.65 to 4.98 per week, whereas the Wexner score changed from 19.91 to 6.82 in the final checkup with Po0.05. In subjects with fecal incontinence (11), the median number of episodes per week in the final follow-up was 1.32 compared with 4.55 pre-SNM. The general and mental health of both groups was measured with the SF-36 questionnaire and consistently showed statistical improvement (Po0.05). Anorectal manometry showed no important variation compared with baseline. There were no major complications. Conclusions: SNM therapy should be considered for the treatment of NBS for select patients with incomplete spinal cord injury when conservative treatments fail.

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Sacral Nerve Stimulation in Fecal Incontinence: Are There Factors Associated with Success?

Abstract: Patients with fecal incontinence from neurologic origins could be good candidates for sacral nerve stimulation.

Cited by 92 publications

References 23 publications

Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury

Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury

Sacral Nerve Neuromodulation Is Effective Treatment for Fecal Incontinence in the Presence of a Sphincter Defect, Pudendal Neuropathy, or Previous Sphincter Repair

Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions

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