PURPOSE: The effect of sacral nerve stimulation was studied in 45 patients with fecal incontinence. METHODS: All patients were initially tested in general anesthesia. Sacral nerves 2, 3, and 4 were tested on both sides. If a perineal/perianal muscular response to sacral nerve stimulation could be obtained, electrodes were implanted for a three-week test-stimulation period. If sacral nerve stimulation resulted in at least a 50 percent reduction in incontinence episodes during the test period, a system for permanent sacral nerve stimulation was implanted. RESULTS: When tested in general anesthesia, 43 of 45 patients had a muscular response to sacral nerve stimulation and had electrodes implanted for the three-week test period. Percutaneous electrodes were used in 34 patients, and 23 of these had at least a 50 percent reduction in incontinence episodes, whereas the electrodes dislocated in 7 patients and 4 had a poor response. Permanent electrodes with percutaneous extension electrodes were used primarily in 9 patients and after dislocation of percutaneous electrodes in an additional 6 patients; 14 of these had a good result. In the last patient, no clinical response to stimulation with the permanent electrode could be obtained. A permanent stimulation system was implanted in 37 patients. After a median of six (range, 0-36) months follow-up, five patients had the system explanted: three because the clinical response faded out, and two because of infection. Incontinence score (Wexner, 0-20) for the 37 patients with a permanent system for sacral nerve stimulation was reduced from median 16 (range, 9-20) before sacral nerve stimulation to median 6 (range, 0-20) at latest follow-up ( P < 0.0001). There was no differences in effect of sacral nerve stimulation in patients with idiopathic incontinence (n = 19) compared with spinal etiology (n = 8) or obstetric cause of incontinence (n = 5). Sacral nerve stimulation did not influence anal pressures or rectal volume tolerability. CONCLUSIONS: Sacral nerve stimulation in fecal incontinence shows promising results. Patients with idiopathic, spinal etiology, or persisting incontinence after sphincter repair may benefit from this minimally invasive treatment.
PURPOSE: The effect of sacral nerve stimulation was studied in 45 patients with fecal incontinence. METHODS: All patients were initially tested in general anesthesia. Sacral nerves 2, 3, and 4 were tested on both sides. If a perineal/perianal muscular response to sacral nerve stimulation could be obtained, electrodes were implanted for a three-week test-stimulation period. If sacral nerve stimulation resulted in at least a 50 percent reduction in incontinence episodes during the test period, a system for permanent sacral nerve stimulation was implanted. RESULTS: When tested in general anesthesia, 43 of 45 patients had a muscular response to sacral nerve stimulation and had electrodes implanted for the three-week test period. Percutaneous electrodes were used in 34 patients, and 23 of these had at least a 50 percent reduction in incontinence episodes, whereas the electrodes dislocated in 7 patients and 4 had a poor response. Permanent electrodes with percutaneous extension electrodes were used primarily in 9 patients and after dislocation of percutaneous electrodes in an additional 6 patients; 14 of these had a good result. In the last patient, no clinical response to stimulation with the permanent electrode could be obtained. A permanent stimulation system was implanted in 37 patients. After a median of six (range, 0-36) months follow-up, five patients had the system explanted: three because the clinical response faded out, and two because of infection. Incontinence score (Wexner, 0-20) for the 37 patients with a permanent system for sacral nerve stimulation was reduced from median 16 (range, 9-20) before sacral nerve stimulation to median 6 (range, 0-20) at latest follow-up ( P < 0.0001). There was no differences in effect of sacral nerve stimulation in patients with idiopathic incontinence (n = 19) compared with spinal etiology (n = 8) or obstetric cause of incontinence (n = 5). Sacral nerve stimulation did not influence anal pressures or rectal volume tolerability. CONCLUSIONS: Sacral nerve stimulation in fecal incontinence shows promising results. Patients with idiopathic, spinal etiology, or persisting incontinence after sphincter repair may benefit from this minimally invasive treatment.
Authors: Andreas M Kaiser; Guy R Orangio; Massarat Zutshi; Suraj Alva; Tracy L Hull; Peter W Marcello; David A Margolin; Janice F Rafferty; W Donald Buie; Steven D Wexner Journal: Surg Endosc Date: 2014-03-08 Impact factor: 4.584
Authors: Alexander Hotouras; Jamie Murphy; Marion Allison; Anne Curry; Norman S Williams; Charles H Knowles; Christopher L Chan Journal: Surg Today Date: 2014-05-05 Impact factor: 2.549
Authors: Brian M Ilfeld; Rodney A Gabriel; Michael F Saulino; John Chae; P Hunter Peckham; Stuart A Grant; Christopher A Gilmore; Michael C Donohue; Matthew G deBock; Amorn Wongsarnpigoon; Joseph W Boggs Journal: Pain Pract Date: 2016-11-11 Impact factor: 3.183