Sacral nerve stimulation for faecal incontinence in the UK

Jarrett, M. E. D.; Varma, J. S.; Duthie, G. S.; Nicholls, R. J.; Kamm, Michael A.

doi:10.1002/bjs.4545

Cited by 140 publications

(148 citation statements)

References 27 publications

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“…9 Further studies have shown similar improvement. 10,11 In a similar manner, it was observed in some of our incontinence patients there was a subjective effect on defecation. Evidence for a possible role in constipation arose initially from urological patients.…”

supporting

confidence: 80%

“…Subsequent reports have confirmed this clinical benefit and have emphasised the safety of this procedure. 10,11 NICE guidelines have been issued for 2005 confirming the safety and efficacy of sacral nerve stimulation for faecal incontinence, leading the way for SNS to be performed as a main-stream treatment when conservative treatment fails, rather than restricted to the research arena alone.…”

Section: Discussionmentioning

confidence: 99%

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Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Kenefick

2006

annals

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INTRODUCTION Incontinence and constipation are common and cause a high degree of physical, social and psychological impairment. Maximal conservative therapy may improve some patients but many remain symptomatic. Surgical options are often unsatisfactory, with variable result and further options are limited. Sacral nerve stimulation uses electrical stimulation applied to the sacral nerves, eliciting a physiological effect on the lower bowel, anal sphincter and pelvic floor, resulting in clinical benefit. The objective of this study was to investigate whether sacral nerve neuromodulation can improve patients with disorders of bowel motility, when current maximal treatment has failed and to investigate the underlying physiological mechanism of action. RESULTSIncontinence: Nineteen patients, age 58 years (range, 37-71 years), with resistant incontinence for 6 years (range, 2-21 years) underwent stimulation. Continence improved in all at 24 months (range, 3-60 months), fourteen fully continent. Incontinent episodes decreased; 12 (range, 2-30) versus 0 (range, 0-4), P < 0.001. Urgency ( P < 0.01) and quality of life improved ( P < 0.05). Anal squeeze pressure ( P = 0.001) and rectal sensation ( P < 0.01) improved.Constipation: Four women, (aged 27-36 years) with resistant idiopathic constipation for 8-32 years underwent the first worldwide implants. Symptoms improved in all with temporary, and in three with permanent, stimulation at 8 months (range, 1-11 months). Bowel frequency increased: 1-5 versus 6-28 evacuations/3-weeks. Symptom scores and quality of life improved.Placebo effect: A double-blind, cross-over study was performed to examine placebo effect and efficacy. Once stimulation was removed, in a blinded manner, symptoms, physiological parameters and quality of life measures rapidly returned to baseline levels.Autonomic neuromodulation: Sixteen patients, median age 59 years (range, 38-71 years), were studied at 27 months (range, 2-62 years) using laser Doppler flowmetry. Chronic stimulation was at 2.8 V (range, 0.3-3.9 V). Median flux differed between none and chronic stimulation (P = 0.001).Step-wise increments caused an immediate, dose-dependent rise in flux ( P < 0.0001) up to 1.0 V. CONCLUSIONS This research provides strong evidence that sacral nerve stimulation can improve patients with resistant incontinence and shows proof-of-concept for the treatment of constipation. The effect is unlikely to be due to placebo and the mechanism is rapidly reversible and involves a dose-dependent effect on the autonomic nerves.

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supporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Kenefick

2006

annals

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“…Tibial nerve stimulation was first used in urology to treat urge-incontinence and overactive bladder syndrome [14,15]. The exact mechanism of PTNS is unknown but some studies showed, as the current study, an increase in maximal squeeze pressure suggesting facilitation of striated muscle function [16]. Increased rectal sensitivity to balloon distention suggests that peripheral neuromodulation affects afferent sensory nerves.…”

Section: Discussionmentioning

confidence: 55%

Percutaneous Tibial Nerve Stimulation for Treatment of Idiopathic Faecal Incontinence: Mid-term Results from a Single Center

Inviati

Giovanni²,

Gullo

et al. 2016

J Gastrointest Dig Syst

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Objective: Percutaneous tibial nerve stimulation is a recent and minimally invasive treatment for faecal incontinence (FI). The aim of this study is to evaluate the mid-term results in patients with idiopathic faecal incontinence (IFI). Methods:Fifty one patients (42 female and 9 male) were prospectively recruited. Patients were treated twice a week for 6 weeks as per study protocol. We have assessed the degree of fecal incontinence using the Cleveland Clinic faecal incontinence (CCF-FI) score at baseline, at 6 weeks, at 6 months and at 1 year. Also the anorectal manometric data (mean resting pressure (MRP), squeeze pressure (SP) and, rectal sensation) at baseline, at 6 weeks and at 6 months have been evaluated. Results:The median CCF-FI score was significantly decreased from an initial baseline value from 12 to 7 at 6 weeks, 3 at 6 months and, 3 at 1 year (respectively: 1st interquartile 4.5, 1, 0 vs 10; 3rd interquartile 9, 5, 5 vs 14.5, p = 0.0001). Anorectal manometry showed an improvement of the internal (resting pressure, MRP) and the external sphincters (squeeze pressure, SP) at 6 months compared to the baseline and 6 weeks by PTNS, while, RP and SP at 6 months was greater than at baseline and 6 weeks (p = 0.004 and p = 0.002 respectively). Conclusions:This study demonstrates that stimulation of the posterior tibial nerve could be an excellent procedure for the treatment of IFI. The stimulation of the posterior tibial nerve can improve the fecal continence (CCF-FI score) in the short term and this improvement is maintained after 1 year of follow-up without treatment.

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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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Sacral nerve stimulation for faecal incontinence in the UK

Abstract: SNS is a safe and effective treatment, in the medium to long term, for faecal incontinence when conservative treatment has failed.

Cited by 140 publications

References 27 publications

Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Percutaneous Tibial Nerve Stimulation for Treatment of Idiopathic Faecal Incontinence: Mid-term Results from a Single Center

Incontinencia fecal del adulto

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