Neuromodulation for fecal incontinence: Outcome in 16 patients with definitive implant

Ganio, Ezio; Ratto, Carlo; Masin, Alessandra; Luc, A. Realis; Doglietto, Giovanni Battista; Dodi, Giuseppe; Ripetti, V.; Arullani, A; Frascio, Marco; Berti-Riboli, E; Landolfi, V.; Delgenio, A.; Altomare, D. F.; Memeo, V.; Bertapelle, Paola; Carone, Roberto; Spinelli, M.; Zanollo, A; Spreafico, L.; Giardiello, G.; Seta, Francesco De

doi:10.1007/bf02235484

Cited by 136 publications

(72 citation statements)

References 16 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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“…La NRS es una terapia de reciente desarrollo y la bibliografía acerca de esta no es extensa (9). Las series publicadas, todas ellas con escaso número de pacientes, muestran resultados similares en cuando a índices de eficacia en torno al 70% (13)(14)(15)(26)(27)(28). En nuestra serie, la NRS ha supuesto una reducción media del valor de continencia en la escala de continencia de Cleveland-Wexner del 67,53%, resultado equiparable a los objetivados por otros grupos.…”

Section: Discussionunclassified

“…Así, la neuromodulación de raíces sacras (NRS), con eficacia clínica demostrada ampliamente en la incontinencia urinaria (7,8), surge como una opción terapéutica reciente y en desarrollo para el tratamiento de la IF (9). A pesar de los escasos estudios publicados (no más de 300 casos en la bibliografía internacional), los resultados iniciales nos sugieren que nos encontramos ante una terapia eficaz con un prometedor futuro, y que las series extensas con seguimientos a largo plazo, acabarán por situarla en un lugar predominante dentro del arsenal terapéutico de la IF (9)(10)(11)(12)(13)(14)(15)(16). Presentamos nuestra experiencia inicial en el tratamiento de la IF mediante la NRS a través de los resultados de un estudio prospectivo realizado con 26 pacientes en cuanto a la variación en la escala de continencia de Wexner-Cleveland y a la capacidad para el retraso de la defecación tras un año de terapia con NRS, realizando además una revisión de las distintas opciones terapéuticas para la IF y mostrando nuestro algoritmo terapéutico para esta patología.…”

Section: Introductionunclassified

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares

Navarro

Sebastián

Vicente

et al. 2007

Rev. esp. enferm. dig.

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INTRODUCCIÓNLa incontinencia fecal (IF) se define como la incapacidad de diferir la defecación hasta que se encuentra el lugar y el momento socialmente idóneos para realizarla, produciéndose una pérdida recurrente e involuntaria de material fecal o gases a través del canal anal. Aún en los casos más leves de IF (en donde únicamente se producen escapes y ensuciamientos de la ropa interior), esta patología conlleva en mayor o menor medida problemas físicos, psicológicos y alteraciones en la calidad de vida de los pacientes (en los ámbitos sexual, familiar, social y laboral) (1-3). Vol. 99. N.°11, pp. 636-642, 2007 Recibido: 20-05-07. Aceptado: 10-09-07. RESUMENPresentamos nuestra experiencia inicial en el tratamiento de la incontinencia fecal (IF) mediante neuromodulación de raíces sacras (NRS), a través de los resultados de un estudio prospectivo realizado con 26 pacientes en el que se comparan los valores basales en la escala de continencia de Wexner-Cleveland y en la capacidad para el retraso de la defecación, con los obtenidos tras un año de terapia con NRS. El estudio inicial de cada paciente incluía anamnesis, exploración general, ecografía y manometría rectal, así como unos diarios de continencia y de calidad de vida específicos para la IF de 3 semanas. Antes de la terapia con NRS, el valor medio en la escala Wexner-Cleveland fue de 15,00 ± 1,81 y el 62,50% de los pacientes tenía una capacidad de retraso de la defecación menor de 1 minuto. Tras un año de terapia con NRS, el valor medio en la escala de Wexner-Cleveland fue de 4,87 ± 2,54 (p = 0,0031) y el 75,01% de los pacientes presentaba una capacidad de retraso defecatorio mayor de 15 minutos (p = 0,0018). Hacemos, además, una descripción detalla de la técnica quirúrgica de la NRS, haciendo referencia a sus indicaciones y finalizamos revisando las distintas opciones terapéuticas para la IF mostrando nuestro algoritmo terapéutico para esta patología. La NRS es una técnica eficaz para el tratamiento de la IF en pacientes seleccionados que no han respondido a tratamiento conservador, biofeedback o correcciones anató-micas (esfinteroplastia), con una mínima morbilidad y susceptible de realizarse en un programa de cirugía ambulatoria.Palabras clave: Incontinencia fecal. Neuromodulación. Raíces sacras. ABSTRACTWe present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compard to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 ± 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 ± 2.54 (p = 0.0031), and 75.01% of patients coul...

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“…Sacral nerve stimulation (SNS) has been used since 1967 to activate bladder voiding (91,132,182,241), to treat bladder incontinence (20,34,44,59,78,108,119,120,122,221,229), to alleviate pelvic pain (1,38,190,279), to prevent fecal incontinence (50,(72)(73)(74)103,153), and to relieve constipation (56,128,133,134,161,166,167,186,189,248,252,272 (87,112,138,147,198,199,219) led to many devices (152,201) for improving walking (81,237), activating hand function (24) through voice commands (94), enhancing coughing (154), and even relieving seating pressures (65). Called neuroprostheses (25,193), these devices often are designed to correct specific deficits, such as foot drop (27,217,245) and hand grasp weakness (47,249,267).…”

Section: Peripheral Nerve Stimulationmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Neuromodulation for fecal incontinence: Outcome in 16 patients with definitive implant

Abstract: Neuromodulation can be considered an option for fecal incontinence. However, an accurate clinical and instrumental evaluation and careful patient selection are required to optimize outcome.

Cited by 136 publications

References 16 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?

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares

Electrical Stimulation and Motor Recovery

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