Controversies in Colorectal Surgery

Techniques in Coloproctology

, Volume 17, Issue 5, pp 589-592

First online:

Sacral nerve stimulation (SNS), posterior tibial nerve stimulation (PTNS) or acupuncture for the treatment for fecal incontinence: a clinical commentary

  • L. HulténAffiliated withDepartment of Surgery, Sahlgrenska University Hospital Email author 
  • , U. AngeråsAffiliated withDepartment of Surgery, Sahlgrenska University Hospital
  • , M. ScagliaAffiliated withDepartment of Surgery, S. Luigi Gonzaga University Hospital
  • , D. DelbroAffiliated withSchool of Health and Medical Sciences, Örebro University

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Sacral nerve stimulation (SNS) has become an established therapy worldwide for the treatment for fecal incontinence. A large number of papers have been published over the years, and SNS is generally considered very effective with improved continence and quality of life for most patients. However, the results are mostly expressed in the semi-quantitative terms, that is, patients’ diaries translated into score points. The clinical value of SNS is questionable, especially as the patient groups are usually small and/or etiologically heterogenic and the follow-up period mostly short. The Health Technology Assessment organization in the west region of Sweden has recently evaluated the SNS with regard to evidence, efficacy and risks. Economic and ethical aspects raise serious questions on this expensive and not entirely risk-free treatment in routine medical care. Similar criticism has also been raised by other reviewers proposing a more thorough scientific assessment with well-designed randomized trials and comparison with other similar methods of treatment.


Fecal incontinence Sacral nerve stimulation Posterior tibial nerve stimulation Acupuncture