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Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS)

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Abstract

Background and purpose

Two types of neuromodulation are currently practised for the treatment of fecal incontinence (FI): sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). This study compares these therapies, as no data exist to prospectively assess their relative efficacy and costs.

Methods

The subjects of this study were two distinct cohorts undergoing SNS (between 2003 and 2008) or PTNS (2008-onwards) for FI. Clinical outcomes assessed at 3 months included incontinence scores and the number of weekly incontinence episodes. The direct medical costs for each procedure were calculated from the audited expenditure of our unit.

Results

Thirty-seven patients (94.6 % women) underwent permanent SNS and 146 (87.7 % women) underwent PTNS. The mean pre-treatment incontinence score (±SD) was greater in the SNS cohort (14 ± 4 vs. 12 ± 4) and the mean post-treatment incontinence scores were similar for the two therapies (9 ± 5 vs. 10 ± 4), with a greater effect size evident in the SNS patients. In a ‘pseudo case–control’ analysis with 37 “matched” patients, the effect of both treatments was similar. The cost of treating a patient for 1 year was £11 374 ($18 223) for permanent SNS vs. £1740 ($2784) for PTNS.

Conclusion

Given the lesser cost and invasive nature of PTNS, where both techniques are available, a trial of PTNS could be considered for all patients.

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Acknowledgments

No funding has been received for this study.

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Authors and Affiliations

  1. Academic Surgical Unit, National Centre for Bowel Research and Surgical Innovation, Barts Health NHS Trust, London, UK

    Alexander Hotouras, Jamie Murphy, Marion Allison, Anne Curry, Norman S. Williams, Charles H. Knowles & Christopher L. Chan

Authors
  1. Alexander Hotouras
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  2. Jamie Murphy
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  3. Marion Allison
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  4. Anne Curry
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  5. Norman S. Williams
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  6. Charles H. Knowles
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  7. Christopher L. Chan
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Correspondence to Alexander Hotouras.

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Hotouras, A., Murphy, J., Allison, M. et al. Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). Surg Today 44, 2124–2130 (2014). https://doi.org/10.1007/s00595-014-0898-0

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  • DOI: https://doi.org/10.1007/s00595-014-0898-0

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