Systematic review of sacral nerve stimulation for faecal incontinence and constipation

Jarrett, M. E. D.; Mowatt, G; Glazener, Cathryn; Fraser, Cynthia; Nicholls, R. J.; Grant, Adrian; Kamm, Michael A.

doi:10.1002/bjs.4796

Cited by 238 publications

(162 citation statements)

References 42 publications

(85 reference statements)

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“…Stimulator malfunction is another potential complication reported in the literature: in our series it was due to a broken electrode in one patient and an exhausted battery in another subject, similar to descriptions by other authors (15). These two cases are in line with other reports that show the technique has no placebo effect, since incontinence recurs when the stimulator is off (16,17).…”

Section: Discussionsupporting

confidence: 90%

Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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Objective: to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation.Patients: fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed.Results: mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean followup is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode.Conclusions: sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate.Key words: Fecal incontinence. Anal sphincter. Anorectal manometry. INTRODUCTIONSacral nerve stimulation in the management of fecal incontinence has led to a change in the diagnostic and therapeutic algorithm for this disease in recent years (1-5). This treatment modality so far removed from the common practice of general surgeons has forced coloproctology specialists to undergo specific education on the technique's theoretical and practical aspects in order to treat their patients.The procedure's absolute indication in fecal incontinence was initially focused on incontinent patients showing integrity of the sphincteric apparatus because of no previous lesions (idiopathic incontinence) or because of a prior sphincteroplaty procedure losing efficacy over time (incontinence most often resulting from obstetric trauma or prior surgery). Its indication has been gradually extended to patients with sphincteric defects (6-10), hence there is an ever increasing number of incontinent patients that are eligible for this procedure, also including stimulators indicated for constipation (11) and pain (12). As with all surgical skills, neuromodulation also displays a learning curve that may be shortened with workshops on stimulators and cadaveric training but cannot be obviated. The goal of this study was to analyze the first fifty cases by three general surgeon teams who used sacral root stimulations for the management of fecal incontinence, and to review the procedure's difficulties and short-term outcomes and complications. MATERIAL AND METHODSThe first fifty patients with fecal incontinence treated with sacral nerve stimulation in four Madrid sites from 2004 to 2009 are retrospectively reviewed. All patients are adults (older t...

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Section: Discussionsupporting

confidence: 90%

Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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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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“…Si se observa una disminución de al menos el 50% de los episodios de incontinencia, se implanta un sistema de estimulación defi nitiva 35 . Esta técnica ha mostrado ser exitosa en la mayoría de las series (70-95%) con una media de seguimiento de un año (35)(36)(37)(38)(39), con baja morbilidad (infección 3-7%) 39 y asociada a mejoría en la calidad de vida. El tratamiento con estimulación de los nervios sacros debe restringirse a pacientes con esfínter anal externo intacto.…”

Section: Neuromodulación Sacraunclassified

Incontinencia fecal del adulto

A¹,

M²,

G³

et al. 2011

Rev Chil Cir

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Fecal incontinence in adultsThe aim of this paper is to review the knowledge of this pathology by highlighting the clinical evolution, study and treatment. These different aspects need a multidisciplinary approach, because of their complex physiopathology, possible association with urinary incontinence and prolapse of the three compartments of the pelvis. The fecal incontinence (FI) constitutes a highly prevalent pathology that affects at least 2% of the population and up to 45% of the patients in nursing homes. This pathology can cause serious problems in physical, psychological, social, and economical levels. The clinical evaluation may identify or suspect the cause, and guide the study of FI. The initial treatment of the FI should always be medical one, often associated to biofeedback and the surgical treatment should be only reserved for refractory FI. Sphincteroplasty is indicated by defi ned defaults of the external sphincter, with good initial results (at least 70%) that fall to 50% in 5 years. The artifi cial neosphincter and the dynamic graciloplasty represent an option for patient without suffi cient sphincter mass for a plasty. In the last few years new techniques have appear with promising results, as the neuromodulation that uses electrodes in the sacral plexus or applied to the posterior tibial nerve. In conclusion the IF is a problem of large prevalence but kept in shadows because the patients tend to have reticence to declare it, and the doctors to inquire about. The focus should be multidisciplinary and the initial treatment must be medical one. The surgical treatment should be reserved for refractory FI.Key words: Fecal incontinence, endosonography, anal manometry, biofeedback, sphincteroplasty. ResumenEl propósito de esta revisión es actualizar los conocimientos sobre esta patología, destacando su evolución clínica, estudio y tratamiento, aspectos que ameritan un enfoque multidisciplinario, ya que, además de su compleja fi siopatología, puede asociarse a incontinencia urinaria y prolapso de los tres compartimentos de la pelvis. La incontinencia fecal (IF) constituye una patología altamente prevalente que afecta al menos un 2% de la población y hasta el 45% de los pacientes en casas de reposo; cuyas consecuencias pueden ocasionar al paciente serios problemas físicos, psicológicos, sociales y económicos. La evaluación clínica puede identifi car o sospechar la causa de la IF, y guiar el estudio de la misma. El tratamiento inicial de la IF debe ser siempre médico, a menudo asociado a biofeedback, y el tratamiento quirúrgico reservarse para la IF refractaria a estas

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Systematic review of sacral nerve stimulation for faecal incontinence and constipation

Abstract: SNS results in significant improvement in faecal incontinence in patients resistant to conservative treatment. Early data also suggest benefit in the treatment of constipation.

Cited by 238 publications

References 42 publications

Sacral nerve stimulation for fecal incontinence

Sacral nerve stimulation for fecal incontinence

New screening technique for sacral nerve stimulation under local anaesthesia

Incontinencia fecal del adulto

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