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Percutaneous tibial nerve stimulation (pTNS): success rate and the role of rectal capacity

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Percutaneous tibial nerve stimulation (pTNS) was originally developed to treat urinary incontinence. Recently, some case series have also documented its success in the treatment of fecal incontinence. Nevertheless, the mechanism underlying this effect remains unknown but may be related to changes in rectal capacity. The aim of this study was to investigate the success of pTNS for the treatment of fecal urge incontinence and assess the influence of rectal capacity on treatment efficacy.

Methods

All patients undergoing pTNS for fecal incontinence between July 2009 and March 2014 were enrolled in a prospective, observational study consisting of a therapeutic regimen that lasted 9 months. Therapy success was defined as a reduction in the CCI (Cleveland Clinic incontinence) score of ≥50% and patient-reported success. Furthermore, quality of life (Rockwood’s scale) and changes in anorectal physiology were recorded.

Results

Fifty-seven patients with fecal urge incontinence were eligible, nine of whom were excluded. The success rate was 72.5%. Incontinence events and urge symptoms were significantly reduced after 3 months and at the end of therapy. The median CCI score decreased from 12 to 4 (P < 0.0001), and the quality of life was significantly improved. However, rectal capacity was not significantly related to treatment success before or after therapy. No adverse events were observed.

Conclusions

These results demonstrate that pTNS can improve the symptoms and quality of life of patients with fecal urge incontinence. However, the study fails to demonstrate a correlation between treatment success and changes in rectal capacity.

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Acknowledgements

The authors thank Ms. Isabella Brenner, the pelvic floor specialist nurse who administered the pTNS therapies to all patients presented here. She was very dedicated and intuitive in caring for the patients.

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Authors and Affiliations

  1. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Lukas Marti, Ulrich Beutner, Nicoletta Pipitone, Katja Wolff, Walter Brunner & Christine Maurus

  2. Department of Surgery, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany

    Lukas Marti & Christian Galata

  3. Department of Surgery, Spital Linth, 8730, Uznach, Switzerland

    Franc Hetzer

  4. Division of Gastroenterology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Jan Borovicka & Michael Christian Sulz

Authors
  1. Lukas Marti
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  2. Christian Galata
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  3. Ulrich Beutner
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  10. Christine Maurus
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Corresponding author

Correspondence to Lukas Marti.

Ethics declarations

The study protocol was reviewed and accepted by the local ethics board and published under www.clinicaltrials.gov, identifier NCT01162525.

Conflict of interest

The work presented here did not receive direct or indirect funding. L.M. received some funding for an educational fellowship 7 years ago from Medtronic, and F. H. was a consultant for Medtronic. Medtronic produces stimulators for SNM but not for pTNS therapy. For research/teaching on unrelated topics conducted by L.M., his institution received some financial support from Covidien-Medtronic, Medtronic, AMI, and Fumedica. The mentioned relationships may have influenced the work presented, although the authors are not aware of such an influence.

Ethical approval

All procedures performed in the study presented involving human participants were performed in accordance with the current version of the Declaration of Helsinki, good clinical practice guidelines, and local legislation. Prior to the inclusion of the first patient, the study had been approved by the ethics committee of the Canton St. Gallen.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Marti, L., Galata, C., Beutner, U. et al. Percutaneous tibial nerve stimulation (pTNS): success rate and the role of rectal capacity. Int J Colorectal Dis 32, 789–796 (2017). https://doi.org/10.1007/s00384-017-2804-x

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  • DOI: https://doi.org/10.1007/s00384-017-2804-x

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