Sacral Nerve Neuromodulation Is Effective Treatment for Fecal Incontinence in the Presence of a Sphincter Defect, Pudendal Neuropathy, or Previous Sphincter Repair

Brouwer, Richard; Duthie, G. S.

doi:10.1007/dcr.0b013e3181ceeb22

Cited by 107 publications

(74 citation statements)

References 14 publications

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“…In our long-term outcomes series, one patient who recently benefited from a sacral nerve stimulation device implantation was operated on by our pediatric surgical team together with an adult team before he was entrusted to the adult team. 38,39 We believe this is an important transition for all cases now.…”

Section: Dyssynergic Defecationmentioning

confidence: 83%

Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

Tran

Mahler

Bontems

et al. 2018

J Neurogastroenterol Motil

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Background/AimsAlthough many advances in the management of Hirschsprung's disease have recently been achieved, postoperative outcomes of these patients remain difficult in a non-negligible number of cases. Therefore, this study aims at investigating characteristics of anorectal manometry and its relationship with postoperative outcomes during long-term follow-up in Hirschsprung patients. MethodsPatients over 4 years of age operated on for Hirschsprung's disease were interviewed to complete detailed questionnaires on bowel function. The patients who consented to undergo an anorectal manometry during follow-up were enrolled in this study. We investigated their clinical characteristics, manometric findings, and their postoperative bowel function. ResultsNineteen patients out of 53 patients (35.8%) were enrolled, 68.4% who were male. Mean age of patients at manometry was 11.3 ± 6.3 years. Twelve out of 19 patients (63.2%) were incontinent. The mean anal resting pressures of incontinent patients were significantly lower than continent patients (47 ± 12 mmHg versus 63 ± 11 mmHg, P < 0.05, t test). Due to neurological impairment, only 11 patients (57.9%) were able to perform a complete manometry. A dyssynergic defecation was found in 4 patients during strain tests. Maximum tolerated volume of the incontinent patients was significantly lower than that of the continent patients (97 ± 67 mL versus 181 ± 74 mL, P < 0.05, t test). ConclusionAnorectal manometry is an objective method providing useful information that could guide a more adapted management in patients with defecation disorders after Hirschsprung's disease operation.

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Section: Dyssynergic Defecationmentioning

confidence: 83%

Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

Tran

Mahler

Bontems

et al. 2018

J Neurogastroenterol Motil

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“…This nerve is most commonly damaged in obstetric trauma and is affected by general neuropathy that may be seen in diabetes or multiple sclerosis. 7 This tool measures the time it takes for stimulation of the pudendal nerve, from the ischial tuberosity to the anal canal, to elicit contraction of the pelvic floor muscles. Delayed response is associated with pudendal neuropathy, which can contribute to FI.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study by Brouwer et al showed no correlation between pudendal nerve latency testing with success after sacral nerve stimulation for FI treatment. 7 Other anal physiologic testing includes sensation testing, magnetic resonance imaging (MRI), and endoscopy. Anorectal sensation testing refers to electrical stimulation of the distal anus as well as urge sensitivity of the rectum with balloon inflation.…”

Section: Discussionmentioning

confidence: 99%

Fecal Incontinence: Etiology, Evaluation, and Treatment

Hayden

Weiss

2011

Clinics in Colon and Rectal Surgery

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Fecal incontinence is a debilitating problem facing 2.2% of the U.S. general population over 65 years of age. Etiologic factors include traumatic, neurologic, congenital, and iatrogenic. Most commonly, obstetric trauma causes fecal incontinence as well as poorly performed anorectal surgery or pelvic radiation. Several severity scores and quality of life indexes have been developed to quantify incontinent symptoms. There are several nonsurgical and surgical options for the treatment of fecal incontinence. Biofeedback is among the most successful nonoperative strategies. Depending on the cause, anal sphincter repair, artificial bowel sphincter, and sacral nerve stimulation are used to treat fecal incontinence with some success. Unfortunately, fecal incontinence is an extremely difficult problem to manage: there has not been one, single treatment option that has proven to be both safe and effective in long-term studies.KEYWORDS: Fecal incontinence, anal sphincter repair, sacral nerve stimulation, artificial bowel sphincter, biofeedbackObjectives: On completion of this article, the reader should be able to summarize the causes and treatment options of fecal incontinence, including both surgical and nonoperative. BACKGROUNDFecal incontinence (FI) is a debilitating and embarrassing problem facing 2.2% of the U.S. general population over 65 years old. 1 This disorder is more prevalent in the elderly population and is one of the most common reasons for nursing home placement. 2,3 The etiology of FI is multifactorial and can be due to several factors including neuropathic, traumatic, congenital, and obstetric trauma, as well as iatrogenic injuries due to injudicious fistula surgery, hemorrhoidectomy, and lateral internal sphincterotomy among several others. FI symptoms can range from mild to severe and the work-up and treatments of this disorder are just as varied. Patients may complain of incontinence to flatus,

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“…However, predictive factors that are necessary to reveal the efficacy of sacral neuromodulation prior to performing it remain to be unclear (33,34). The efficacy of sacral neuromodulation in partial sphincter injury has also been demonstrated (35)(36)(37). In patients with scleroderma having proctitis caused by radiation and reduced rectal compliance owing to inflammatory bowel syndrome and in patients with anterior resection or previous rectal prolapse colectomy, the efficacy of sacral neuromodulation is demonstrated only in few studies (38)(39)(40)(41)(42)(43).…”

Section: Gastrointestinal Disordersmentioning

confidence: 99%

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

Ozyalcin¹

2015

Turk J Phys Med Rehab

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The aim of this article is to determine the effectiveness and the safety of sacral nerve stimulation on the several indications. Sacral nerve stimulation as a neuromodulation technique, is an effective and increasingly used therapeutic option. As a minimally invasive technique, many advances in the techniques for sacral neuromodulation have been described. The well-known indication of sacral nerve stimulation is the urinary voiding dysfunction. Although the mechanism of neuromodulation is still unclear, multipl new indications have been identified, include faecal incontinence, constipation, pain sydromes, interstitial cystitis, mixt urinary and bowel disoders, spinal injury and neurodegenerative disease, and sexual dysfunction. Since there is lack of high quality evidence of the procedure at present, good quality prospective, cross-over and randomize controlled studies are required to determine the true benefits of sacral nerve stimulation.

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Sacral Nerve Neuromodulation Is Effective Treatment for Fecal Incontinence in the Presence of a Sphincter Defect, Pudendal Neuropathy, or Previous Sphincter Repair

Abstract: Sacral nerve neuromodulation results in a significant improvement in fecal incontinence and Fecal Incontinence Quality of Life scores after medium-term follow-up, even when there is a sphincter defect or pudendal neuropathy.

Cited by 107 publications

References 14 publications

Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

Fecal Incontinence: Etiology, Evaluation, and Treatment

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

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