Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations

Abstract

Objective Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively.Method Patients treated between March 2000 and May 2005 were included. Faecal incontinence was defined as at least one episode of involuntary faecal loss per week confirmed by a 3-week bowel habit diary. Patients were eligible for implantation of a permanent SNM when showing at least a 50% reduction in incontinence episodes or days during ambulatory test stimulation. Preoperative workup consisted of an X-defaecography, pudendal nerve terminal motor latency measurement, endo-anal ultrasound and anal manometry. The follow-up visits for the permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. The bowel habit diary and anal manometry were repeated postoperatively during the follow-up visits.Results A total of 134 patients were included and received a subchronic test stimulation. One hundred patients (74.6%) had a positive test stimulation and received a definitive SNM implantation. The permanent implantation group consisted of 89 women and 11 men. The mean age was 55 years (range 26-75). The mean follow-up was 25.5 months (range 2.5-63.2). The mean number of incontinence episodes decreased significantly during the test stimulation (baseline, 31.3; test, 4.4; P < 0.0001) and at follow-up (36 months postoperatively, 4.8; P < 0.0001). There was no significant change in the mean anal resting pressure. The squeeze pressures were significantly higher at 6 months (109.8 mmHg; P ¼ 0.03), 12 months (114.1 mmHg; P ¼ 0.02) and 24 months postoperatively (113.5 mmHg; P ¼ 0.007). The first sensation, urge and maximum tolerable volume did not change significantly. Twenty-one patients were considered late failures and received further treatment.Conclusion Sacral neuromodulation is an effective treatment for FI. The medium-term results were satisfying.

Successful sacral nerve modulation despite migration of tined lead

“…[10] The left or right sacral foramen S3 is the nerve root most frequently chosen when implanting a temporary or permanent lead, since it leads to the best motor responses based on the experience of different research groups. [4,11] This is in accord with the anatomic origin of the innervation of the detrusor muscle and sphincter. Surprisingly S2 and S4 can occasionally elicit the best responses and the area where contact provokes responses indicative of an electrode position in S3 and S4 can vary widely among patients.…”

Comparison of percutaneous tibial nerve stimulation and bulking agent injection (polyacrylonitrile) in treating fecal incontinence

“…5,6,7,8,9,10 SNS, which is initially used to treat urinary incontinence, was first used by Matzel et al 11 to treat FI, and a success rate of up to 75% has been reported in subsequent studies. 19 However, this invasive procedure requires two surgeries under general or local anesthesia and has specific morbidities. 20,21 PTNS is cheaper and less invasive than SNS; PTNS can also be performed without anesthesia with similar success rates.…”

Sacral nerve stimulation for fecal incontinence

“…In our study, following the procedure we saw that voluntary contraction pressure improved in a statistically significant manner. Despite such disparity in manometric results, all authors conclude that sacral neuromodulation is a highly effective approach for the management of fecal incontinence, no matter if manometric improvement was mediated by increased rectal capacity or higher sphincteric pressures (22). Thus, we believe this technique's usefulness may be assessed using continence scales or quality of life questionnaires, with no need for anorectal manometry during the postoperative period.…”