Success and Complication Rates After Sacral Neuromodulation for Fecal Incontinence and Constipation: A Single-center Follow-up Study

Abstract

Background/AimsThe aim of this study was to evaluate the sustainability of sacral neuromodulation (SNM) success in patients with fecal incontinence (FI) and/or constipation.MethodsThis is a retrospective analysis of a prospective database of patients who received SNM therapy for FI and/or constipation between 2006 and 2015. Success rates, complications and reintervention rates were assessed after up to 10 years of follow-up.ResultsElectrodes for test stimulation were implanted in 101 patients, of whom 79 (78.2%) received permanent stimulation. The mean follow-up was 4.4 ± 3.0 years. At the end of follow-up, 57 patients (72.2%) were still receiving SNM. The 5-year success rate for FI and isolated constipation was 88.2% (95% confidence interval [CI], 80.1–97.0%) and 31.2% (95% CI, 10.2–95.5%), respectively (P < 0.001). In patients with FI, involuntary evacuations per week decreased > 50% in 76.1% of patients (95% CI, 67.6–86.2%) after 5 years. A lead position at S3 was associated with an improved outcome (P = 0.04). Battery exchange was necessary in 23 patients (29.1%), with a median battery life of 6.2 years. Reinterventions due to complications were necessary in 24 patients (30.4%). For these patients, the 5-year success rate was 89.0% (95% CI, 75.3–100.0%) compared to 78.4% (95% CI, 67.2–91.4%) for patients without reintervention.ConclusionsSNM offers an effective sustainable treatment for FI. For constipation, lasting success of SNM is limited and is thus not recommended. Reinterventions are necessary but do not impede treatment success.

New Technologies and Applications in Sacral Neuromodulation: An Update

“…A second issue relates to the requirement for battery (IPG) changes. The battery life of rechargeable devices has been estimated as 15 years compared to the longevity of the current InterStim II (IPG), which in clinical practice is about 5-7 years [11][12][13]. As a result of the claimed longer battery life of a rechargeable IPG, it has therefore been suggested that this therapy is associated with a reduced need for reoperation [14].…”

Interdisciplinary Laparoscopic Implantation of Neuromodulation Leads to the Sacral Plexus for Therapy of Chronic Pelvic Pain and Neurogenic Bladder Dysfunctions

“…The treatment of CPP and the therapy of incontinence after EM extraction is difficult and to this day still insufficient. S3 stimulation for incontinence by percutaneous or subcutaneous implantation techniques are based on blind implantation of the electrode (22,23). A great improvement in the treatment of pelvic pain was the LION technique introduced by Possover et al who first reported about the surgical and neuromodulative treatment options of sacral nerve stimulation after laparoscopic treatment of EM (2,19).…”

Effects of temporary sacral nerve stimulation on gastrointestinal motility and function in patients with chronic refractory slow-transit constipation

“…Several studies and even a metanalysis exist on SNS for chronic constipation. While initial reports, on the wings of the enthusiasm around SNS, show a high success rate (over 70%) [5], almost all the subsequent studies have reported disappointing results after medium-/long-term evaluation, with a success rate around 30% [6][7][8][9][10][11].…”

“…SNS also improves other pelvic floor dysfunctions such as urinary retention [3], and constipation [4]. In particular, studies suggest improvement in constipation symptoms after SNS in both slow-transit and obstructed defecation, with success rates which vary from 22 to 73% depending on the length of the follow-up, irrespectively of the type of constipation [4][5][6][7][8][9][10][11]. However, the mechanisms of action of SNS have not yet been entirely elucidated.…”