Six Years of Experience With Sacral Nerve Stimulation for Fecal Incontinence

Michelsen, Hanne B.; Thompson‐Fawcett, Mark; Lundby, Lilli; Krogh, Klaus; Laurberg, Søren; Buntzen, Steen

doi:10.1007/dcr.0b013e3181ca7dc2

Cited by 91 publications

(56 citation statements)

References 40 publications

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“…This is a procedure that in the reviewed literature has a low complication or adverse effects rate, including surgical site infection. The incidence of infection in our series was 4%, a value similar to that described in other studies (range 1.6-10.8%) (13,14). In both cases infection occurred after definitive pacemaker implantation and prompted its withdrawal.…”

Section: Discussionsupporting

confidence: 89%

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: 89%

Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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“…Our study supports the findings of Brouwer and Duthie who demonstrated no correlation between pudendal nerve latency testing and outcomes following SNM [26]. Studies looking at the mechanism of action of SNM have shown that in addition to improvement in muscle function, SNM also modulates sacral reflexes that regulate rectal sensitivity and contractility, anal motility and brain activity relevant to the continence mechanism [27][28][29]. It may be possible that current testing modalities are simply not able to detect which of the stages in these complex interactions are predictive of success with SNM.…”

Section: Discussionsupporting

confidence: 89%

Does Preoperative Anal Physiology Testing or Ultrasonography Predict Clinical Outcome With Sacral Neuromodulation for Fecal Incontinence?

Quezada

Whiteside

Rice

et al. 2016

Obstetrical &Amp; Gynecological Survey

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“…The PNE test is conducted over a period of 2-3 weeks. A positive test response is achieved for 70 %-90 % of patients (19)(20)(21)(22). In those who have an implanted stimulator, the effect is sustained in 70 %-90 % after 2-5 years (19,22,23).…”

Section: Anal Incontinencementioning

confidence: 99%

Sakralnervestimulering

Norderval¹,

Rydningen²,

Lindsetmo³

et al. 2011

Tidsskriftet

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SummaryBackground. Sacral nerve stimulation involves electrical stimulation of a sacral nerve root by means of an electrode and a stimulator. In the course of just a few years, sacral nerve stimulation has become a treatment option for selected patients with urinary retention, urinary incontinence, anal incontinence and constipation. The method is also being tested in connection with several other indications.

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Six Years of Experience With Sacral Nerve Stimulation for Fecal Incontinence

Cited by 91 publications

References 40 publications

Sacral nerve stimulation for fecal incontinence

Sacral nerve stimulation for fecal incontinence

Does Preoperative Anal Physiology Testing or Ultrasonography Predict Clinical Outcome With Sacral Neuromodulation for Fecal Incontinence?

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