Sacral neuromodulation: time to seize the opportunity to collaborate on a ‘de-prioritised’ service?

O'Connor, Alexander; Mullins, D; Sharma, Abhiram; Faulkner, G; Telford, Karen

doi:10.1007/s10151-023-02785-3

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…If a potential association between PTNS and PNE success is confirmed in clinical trials, previous PTNS success could be considered sufficient criteria for permanent SNS implantation. Alternatively, PTNS could be offered as an effective treatment option before SNS ( 14 ), or to those patients waiting for SNS surgery which have suffered delays in recent years ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence

O’Connor,

Reynolds,

Molyneux

et al. 2024

Front. Surg.

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IntroductionFaecal incontinence (FI) is a common condition with a significant impact on quality of life (QoL). Neuromodulation treatments delivered by members of the multidisciplinary team including sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS) are options for FI refractory to conservative management. The aim of this study was to assess whether a successful treatment with one neuromodulation modality corresponds with success in the other.MethodsA retrospective review of a prospectively managed neuromodulation database identified 15 patients who had undergone both PTNS and SNS. The definition of success of each treatment was a >50% improvement in any of The St. Mark's Incontinence Score, Manchester Health Questionnaire, or weekly faecal urgency or FI episodes.ResultsComplete data from 12 patients was available for assessment and PTNS was delivered as the first treatment in nine patients. Overall, seven patients (58%) had successful PTNS treatment, with 10 (83%) having a successful SNS trials. Of the seven patients who had successful PTNS treatment, six patients (85.4%) went on to have success with SNS. Of the five patients who failed PTNS, four (80%) went on to have SNS success. Five (71%) of those who had positive PTNS outcomes had permanent SNS implantation as their final treatment decision.ConclusionThis study suggests that there is no clear relationship between successful PTNS treatment and an SNS trial period which may be explained by differing mechanisms of action or the potential placebo effect of PTNS. Further work is required to investigate any association in larger studies to inform clinical practice.

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Section: Discussionmentioning

confidence: 99%

Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence

O’Connor,

Reynolds,

Molyneux

et al. 2024

Front. Surg.

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Patient Satisfaction With Long-term Sacral Neuromodulation for Fecal Incontinence: Experience From a Single Tertiary Center

Martin,

O’Connor,

Selvakumar

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Sacral Neuromodulation is an effective treatment for faecal incontinence in the long-term. Efficacy is typically assessed using bowel diary, symptom severity, or quality of life questionnaires and ‘success’ defined as >50% improvement in these measures. Patient satisfaction may however be a more meaningful and individualised measure of treatment efficacy. OBJECTIVE: To assess patient reported satisfaction with long-term sacral neuromodulation and compare it to the frequently applied efficacy measures. DESIGN: An observational study of a prospectively maintained database. SETTING: A single tertiary pelvic floor referral unit. PATIENTS: Data from 70 (68 female, median age 69 [60 – 74]) patients were available. The median time since implantation was 11 (9 – 14) years. Nineteen patients reported inactive neuromodulation devices. MAIN OUTCOME MEASURES: Bowel diaries, the Manchester Health Questionnaire, and the St Marks Incontinence Score recorded at baseline, after percutaneous nerve evaluation, and at last follow-up. Patient reported satisfaction, using a 0%-100% visual analogue scale, with treatment since implantation (overall) and in the two-weeks preceding completion of the last outcome measures (current). RESULTS: Satisfaction was significantly higher in those with active sacral neuromodulation devices (75% vs 20%, p<0.001) at follow-up. No significant relationships exist between symptom improvement using conventional measures, and patient reported satisfaction. Current satisfaction was not associated with changes in bowel diary data following percutaneous nerve evaluation. Despite improvements in the St Mark’s incontinence score and Manchester Health Questionnaire below the 50% improvement threshold used to define ‘success’, patients reported high (80%) satisfaction. LIMITATIONS: Retrospective with gaps in the available data. CONCLUSIONS: High patient satisfaction with sacral neuromodulation can be achieved, however the response to percutaneous nerve evaluation may not predict treatment satisfaction in long-term. The change in questionnaire results, which measure the use of compensatory behaviors and quality of life impact, may better correspond to treatment satisfaction.

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Sacral neuromodulation: time to seize the opportunity to collaborate on a ‘de-prioritised’ service?

Cited by 2 publications

References 4 publications

Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence

Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence

Patient Satisfaction With Long-term Sacral Neuromodulation for Fecal Incontinence: Experience From a Single Tertiary Center

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