International Journal of Colorectal Disease

, Volume 31, Issue 2, pp 439–444 | Cite as

Exhausted implanted pulse generator in sacral nerve stimulation for faecal incontinence: What next in daily practice for patients?

  • Emilie DuchalaisEmail author
  • Guillaume Meurette
  • Bastien Perrot
  • Vincent Wyart
  • Caroline Kubis
  • Paul-Antoine Lehur
Original Article



The efficacy of sacral nerve stimulation in faecal incontinence relies on an implanted pulse generator known to have a limited lifespan. The long-term use of sacral nerve stimulation raises concerns about the true lifespan of generators. The aim of the study was to assess the lifespan of sacral nerve stimulation implanted pulse generators in daily practice, and the outcome of exhausted generator replacement, in faecal incontinent patients.


Faecal incontinent patients with pulse generators (Medtronic Interstim™ or InterstimII™) implanted in a single centre from 2001 to 2014 were prospectively followed up. Generator lifespan was measured according to the Kaplan-Meier method. Patients with a generator explanted/turned off before exhaustion were excluded. Morbidity of exhausted generator replacement and the outcome (Cleveland Clinic Florida Faecal Incontinence (CCF-FI) and Faecal Incontinence Quality of Life (FIQL) scores) were recorded.


Of 135 patients with an implanted pulse generator, 112 (InterstimII™ 66) were included. Mean follow-up was 4.9 ± 2.8 years. The generator reached exhaustion in 29 (26 %) cases. Overall median lifespan of an implanted pulse generator was approximately 9 years (95 % CI 8–9.2). Interstim™ and InterstimII™ 25th percentile lifespan was 7.2 (CI 6.4–8.3) and 5 (CI 4–not reached) years, respectively. After exhaustion, generators were replaced, left in place or explanted in 23, 2 and 4 patients, respectively. Generator replacement was virtually uneventful. CCF-FI/FIQL scores remained unchanged after generator replacement (CCF-FI 8 ± 2 vs 7 ± 3; FIQL 3 ± 0.6 vs 3 ± 0.5; p = ns).


In this study, the implanted pulse generator observed median lifespan was 9 years. After exhaustion, generators were safely and efficiently replaced. The study also gives insight into long-term needs and costs of sacral nerve stimulation (SNS) therapy.


Sacral nerve stimulation Implanted pulse generator Battery exhaustion Faecal incontinence Outcome 



The authors are grateful to Mrs Nelly Rondeau-Moreau for her participation in the acquisition of the data and to Mr Andrew Spiers for his critical comments.

Compliance with ethical standards


The study was supported in part by the “Centre d’études et de recherches en chirurgie” (CEREC) of the University Hospital of Nantes.

Conflict of interest

Paul-Antoine Lehur has received honoraria from Medtronic as a speaker at meetings.


  1. 1.
    Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127CrossRefPubMedGoogle Scholar
  2. 2.
    Tjandra JJ, Chan MKY, Yeh CH, Murray-Green C (2008) Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 51:494–502CrossRefPubMedGoogle Scholar
  3. 3.
    Altomare DF, Giuratrabocchetta S, Knowles CH, Muñoz Duyos A, Robert-Yap J, Matzel KE (2015) Long-term outcomes of sacral nerve stimulation for faecal incontinence. Br J Surg 102:407–415CrossRefPubMedGoogle Scholar
  4. 4.
    Hull T, Giese C, Wexner SD, Mellgren A, Devroede G, Madoff RD et al (2013) Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum 56:234–245CrossRefPubMedGoogle Scholar
  5. 5.
    Jarrett MED, Varma JS, Duthie GS, Nicholls RJ, Kamm MA (2004) Sacral nerve stimulation for faecal incontinence in the UK. Br J Surg 91:755–761CrossRefPubMedGoogle Scholar
  6. 6.
    Maeda Y, Lundby L, Buntzen S, Laurberg S (2014) Outcome of sacral nerve stimulation for fecal incontinence at 5 years. Ann Surg 259:1126–1131CrossRefPubMedGoogle Scholar
  7. 7.
    Uludağ O, Melenhorst J, Koch SMP, van Gemert WG, Dejong CHC, Baeten CGMI (2011) Sacral neuromodulation: long-term outcome and quality of life in patients with faecal incontinence. Color Dis 13:1162–1166CrossRefGoogle Scholar
  8. 8.
    Mitchell PJ, Sagar PM (2014) Emerging surgical therapies for faecal incontinence. Nat Rev Gastroenterol Hepatol 11:279–286CrossRefPubMedGoogle Scholar
  9. 9.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefPubMedGoogle Scholar
  10. 10.
    Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG et al (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16, discussion 16–17 CrossRefPubMedGoogle Scholar
  11. 11.
    Brazzelli M, Murray A, Fraser C (2006) Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol 175:835–841CrossRefPubMedGoogle Scholar
  12. 12.
    Gajewski JB, Al-Zahrani AA (2011) The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre. BJU Int 107:1258–1264CrossRefPubMedGoogle Scholar
  13. 13.
    Herbison GP, Arnold EP (2009) Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane database Syst Rev. CD004202Google Scholar
  14. 14.
    Altomare DF, Giannini I, Giuratrabocchetta S, Digennaro R (2013) The effects of sacral nerve stimulation on continence are temporarily maintained after turning the stimulator off. Color Dis 15:e741–e748CrossRefGoogle Scholar
  15. 15.
    Powell CR, Kreder KJ (2010) Long-term outcomes of urgency-frequency syndrome due to painful bladder syndrome treated with sacral neuromodulation and analysis of failures. J Urol 183:173–176CrossRefPubMedGoogle Scholar
  16. 16.
    Barussaud M-L, Mantoo S, Wyart V, Meurette G, Lehur P-A (2013) The magnetic anal sphincter in faecal incontinence: is initial success sustained over time? Color Dis 15:1499–1503CrossRefGoogle Scholar
  17. 17.
    McMullin CM, Jadav AM, Hanwell C, Brown SR (2014) Resource implications of running a sacral neuromodulation service: a 10-year experience. Color Dis 16:719–722CrossRefGoogle Scholar
  18. 18.
    Muñoz-Duyos A, Navarro-Luna A, Brosa M, Pando JA, Sitges-Serra A, Marco-Molina C (2008) Clinical and cost effectiveness of sacral nerve stimulation for faecal incontinence. Br J Surg 95:1037–1043CrossRefPubMedGoogle Scholar
  19. 19.
    Leroi A-M, Lenne X, Dervaux B, Chartier-Kastler E, Mauroy B, Le Normand L et al (2011) Outcome and cost analysis of sacral nerve modulation for treating urinary and/or fecal incontinence. Ann Surg 253:720–732CrossRefPubMedGoogle Scholar
  20. 20.
    Hetzer FH, Bieler A, Hahnloser D, Löhlein F, Clavien P-A, Demartines N (2006) Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 93:1411–1417CrossRefPubMedGoogle Scholar
  21. 21.
    Dudding TC, Meng Lee E, Faiz O, Parés D, Vaizey CJ, McGuire A et al (2008) Economic evaluation of sacral nerve stimulation for faecal incontinence. Br J Surg 95:1155–1163CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Emilie Duchalais
    • 1
    Email author
  • Guillaume Meurette
    • 1
  • Bastien Perrot
    • 2
  • Vincent Wyart
    • 1
  • Caroline Kubis
    • 1
  • Paul-Antoine Lehur
    • 1
  1. 1.Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l’Appareil DigestifUniversity Hospital of NantesNantesFrance
  2. 2.EA4275-SPHERE “Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences”University of NantesNantesFrance

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