Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up
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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.
KeywordsSacral nerve modulation Sacral nerve stimulation Fecal incontinence Urinary incontinence Double incontinence Quality of life
Department of Colorectal Surgery CCF
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