Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up
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- El-Gazzaz, G., Zutshi, M., Salcedo, L. et al. Int J Colorectal Dis (2009) 24: 1377. doi:10.1007/s00384-009-0745-8
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The purpose of this study was to evaluate improvement in symptoms of fecal incontinence (FI) in a group of women who also had urinary incontinence (UI) and were successfully implanted with the sacral neuromodulation (SNM) device primarily for urinary incontinence in one US institution.
Twenty-four patients with FI and UI who failed to improve with conservative or standard surgical treatment underwent permanent SNM after a successful peripheral nerve stimulation test during 2003–2007. Wexner incontinence score, fecal incontinence quality of life (FIQL), and Bristol stool scales were recorded before and after treatment. Follow-up was done by questionnaires contact.
Twenty-four patients (mean age 56.5 ± 5.3 years) were studied. The median follow-up was 28 months (range 3–49). Twenty-two patients (92%) were contacted. Seven patients (31.8%) experienced improvement in both urinary and fecal incontinence symptoms. Twelve patients (54.5%) experienced no improvement in FI symptoms after SNM. Four patients required a colostomy or ileostomy; four had the system explanted (two, due to a faded clinical response and two, due to infection); and four other patients experienced no improvement after SNM. The outcomes of ten patients (45.5%) with functioning SNM were reviewed. There were significant improvement of FI symptoms with a significantly lower Wexner score from 12.0 ± 2.0 before SNM to 4.7 ± 3.6 (p = 0.009). The mean FIQL scores improved significantly from the baseline score 7.8 ± 0.8 before SNM to 13.5 ± 2.6 (p = 0.009). Bristol stool form scale was reduced significantly from 4.5 to 3.5 after SNM (p = 0.02).
SNM may be beneficial in selected female patients with UI associated with FI. Prospective trials may help delineate which patients will show FI improvement in this combined group.