Sacral Neuromodulation in Patients With Fecal Incontinence: A Single-Center Study

Uludag, Ö; Koch, S. M. P.; Gemert, Wim G. van; Dejong, C. H. C.; Baeten, C. G. M. I.

doi:10.1007/s10350-004-0589-9

Cited by 113 publications

(89 citation statements)

References 48 publications

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“…The median follow-up period was 29.2 months (range 6.5-60.0) and the median period between the last AR and the PNE was 3 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. All had an intact anal sphincter determined by endo-anal ultrasound.…”

Section: Group Amentioning

confidence: 99%

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Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?

et al. 2007

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Objective Sacral nerve modulation (SNM) for the treatment of faecal incontinence was originally performed in patients with an intact anal sphincter or after repair of a sphincter defect. There is evidence that SNM can be performed in patients with faecal incontinence and an anal sphincter defect.Method Two groups of patients were analysed retrospectively to determine whether SNM is as effective in patients with faecal incontinence associated with an anal sphincter defect as in those with a morphologically intact anal sphincter following anal repair (AR). Patients in group A had had an AR resulting in an intact anal sphincter ring. Group B included patients with a sphincter defect which was not primarily repaired. Both groups underwent SNM. All patients had undergone a test stimulation percutaneous nerve evaluation (PNE) followed by a subchronic test over 3 weeks. If the PNE was successful, a permanent SNM electrode was implanted. Follow-up visits for the successfully permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter.Results Group A consisted of 20 (19 women) patients. Eighteen (90%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle-term follow-up. Group B consisted of 20 women. The size of the defect in the anal sphincter varied between 17% and 33% of the anal circumference. Fourteen (70%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle-term follow-up. In both groups, the mean number of incontinence episodes decreased significantly with SNM (test vs baseline: P = 0.0001, P = 0.0002). There was no significant difference in resting and squeeze pressures during SNM in group A, but in group B squeeze pressure had increased significantly at 24 months. Comparison of patient characteristics and outcome between groups A and B revealed no statistical differences.Conclusion A morphologically intact anal sphincter is not a prerequisite for success in the treatment of faecal incontinence with SNM. An anal sphincter defect of <33% of the circumference can be effectively treated primarily with SNM without repair.

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Section: Group Amentioning

confidence: 99%

“…In 1995, Matzel et al [12] published their results of SNM applied to faecal incontinence. Since then, many studies demonstrated the efficacy of SNM for the treatment of faecal incontinence [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?

et al. 2007

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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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“…Most FI is caused by an interaction of various pathophysiological factors, including abnormal anorectal sensation, colorectal motility as well as anatomical changes to the pelvic floor and sphincter complex [1][2]. Nevertheless, it mainly affects females as a result of direct damage to the anal sphincter(s) or indirect damage caused by stretching of the pudendal nerve during childbirth [3]. This common problem, which persists especially in older population, leads to physical and psychological disability and social isolation.…”

Section: Introductionmentioning

confidence: 99%

Sacral Neuromodulation for the Treatment of Faecal Incontinence: First Steps in Lithuania

et al. 2015

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SummaryTwo female patients with faecal incontinence resistant to conservative treatment but improved after percutaneous tibial nerve neuromodulation were treated with sacral nerve neuromodulation in 2014. Quality of Life questionnaires were used in order to determine the impact of faecal incontinence on everyday life before and after the implantation of the stimulator. To evaluate the functional state, Wexner's questionnaires were applied. Bowel movement diary was used to detect the improvement of faecal continence before and after temporary and permanent neuromodulation. The data were analyzed using a Statistical Package for Social Sciences program (SPSS, version 22.0). All values were given as mean ± SD. P-values less than 0.05 were accepted to indicate statistical significance. Both patients had a reduction in episodes of incontinence and soiling during a 3 week temporary nerve stimulation period as well as during 3 week followup after permanent stimulator implantation. Statistically significant elevation of faecal urgency frequency (p=0.031) was observed during temporary nerve stimulation. Reduction of episodes of faecal incontinence (p=0.001) and soiling (p=0.000) was observed after permanent stimulator implantation. Both patients presented an improvement in lifestyle, coping, depression and embarrassment as well as an improvement in functional state 3 weeks after the beginning of sacral nerve stimulation. Conclusions: The first results of sacral neuromodulation in patients with faecal incontinence are excellent and very promising.

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Sacral Neuromodulation in Patients With Fecal Incontinence: A Single-Center Study

Abstract: Sacral neuromodulation is a feasible treatment option for fecal incontinence in patients with structurally intact sphincters.

Cited by 113 publications

References 48 publications

Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?

Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?

New screening technique for sacral nerve stimulation under local anaesthesia

Sacral Neuromodulation for the Treatment of Faecal Incontinence: First Steps in Lithuania

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