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Efficacy of cyclic sacral nerve stimulation for faecal incontinence

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Abstract

Background

Sacral nerve stimulation (SNS) is an established treatment option for faecal incontinence. Cyclic stimulation will improve the longevity of the implanted stimulator, but little is known about its efficacy. The aim of this retrospective clinical study was to assess the efficacy of cyclic SNS for faecal incontinence.

Methods

Sixty-three patients underwent percutaneous nerve evaluation (PNE) test with a 2-week period of continuous SNS. The PNE test was deemed positive in 42 patients (67 %) who underwent implantation with permanent stimulator. All 42 patients were initially stimulated in a cyclic manner with stimulation for 20 s followed by 8 s without. During follow-up, the stimulator was explanted in 2 patients and permanently turned off in one due to the loss of effect. A postal questionnaire including the Wexner score, a general quality of life (Qol) score, and a bowel habit diary was distributed to 39 patients.

Results

The questionnaire was returned by 29/39 (74 %) of the patients. Median duration of follow-up was 16 (range 3–34) months. The Wexner score and the general QoL score were significantly improved compared to pre-treatment values. Some 18 patients (62 %) were still treated with cyclic stimulation at follow-up, reporting more frequent episodes of urgency without incontinence (p = 0.020) compared to symptoms during the PNE test. Patients who had changed to continuous stimulation due to a suboptimal effect during follow-up reported more frequent episodes of urgency with incontinence (p = 0.034), minor soiling (p = 0.045) and days wearing pads (p = 0.027) compared with symptoms during the PNE test.

Conclusions

Cyclic stimulation seems effective for most patients treated with SNS for faecal incontinence.

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References

  1. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127

    Article  PubMed  CAS  Google Scholar 

  2. Hollingshead JR, Dudding TC, Vaizey CJ (2011) Sacral nerve stimulation for faecal incontinence: results from a single centre over a 10 year period. Colorectal Dis 13:1030–1034

    Article  PubMed  CAS  Google Scholar 

  3. Wexner SD, Coller JA, Devroede G et al (2010) Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg 251:441–449

    Article  PubMed  Google Scholar 

  4. Melenhorst J, Koch SM, Uludag O, van Gemert WG, Baeten CG (2007) Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations. Colorectal Dis 9:725–730

    Article  PubMed  CAS  Google Scholar 

  5. Melenhorst J, Koch SM, Uludag O, van Gemert WG, Baeten CG (2008) Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence? Colorectal Dis 10:257–262

    Article  PubMed  CAS  Google Scholar 

  6. Brouwer R, Duthie G (2010) Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum 53:273–278

    Article  PubMed  Google Scholar 

  7. Malaguti S, Spinelli M, Giardiello G, Lazzeri M, Van Den Hombergh U (2003) Neurophysiological evidence may predict the outcome of sacral neuromodulation. J Urol 170:2323–2326

    Article  PubMed  CAS  Google Scholar 

  8. Leng WW, Chancellor MB (2005) How sacral nerve stimulation neuromodulation works. Urol Clin N Am 32:11–18

    Article  Google Scholar 

  9. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  10. Bierman AS, Bubolz TA, Fisher ES, Wasson JH (1999) How well does a single question about health predict the financial health of medicare managed care plans? Eff Clin Pract 2:56–62

    PubMed  CAS  Google Scholar 

  11. Govaert B, Rietveld MP, van Gemert WG, Baeten CG (2011) The role of reprogramming in sacral nerve modulation for faecal incontinence. Colorectal Dis 13:78–81

    Article  PubMed  CAS  Google Scholar 

  12. Hijaz A, Vasavada SP, Daneshgari F, Frinjari H, Goldman H, Rackley R (2006) Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience. Urology 68:533–537

    Article  PubMed  Google Scholar 

  13. Michelsen HB, Thompson-Fawcett M, Lundby L, Krogh K, Laurberg S, Buntzen S (2010) Six years of experience with sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 53:414–421

    Article  PubMed  Google Scholar 

  14. Wong MT, Meurette G, Rodat F, Regenet N, Wyart V, Lehur PA (2011) Outcome and management of patients in whom sacral nerve stimulation for fecal incontinence failed. Dis Colon Rectum 54:425–432

    Article  PubMed  Google Scholar 

  15. Munoz-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 95:1037–1043

    Article  PubMed  CAS  Google Scholar 

  16. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ (2000) Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 43:298–302

    Article  PubMed  CAS  Google Scholar 

  17. Leroi AM, Parc Y, Lehur PA et al (2005) Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 242:662–669

    Article  PubMed  Google Scholar 

  18. Dudding TC, Vaizey CJ, Gibbs A, Kamm MA (2009) Improving the efficacy of sacral nerve stimulation for faecal incontinence by alteration of stimulation parameters. Br J Surg 96:778–784

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

Stig Norderval has received honoraria for lectures given at courses arranged by Medtronic.

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Authors and Affiliations

  1. Suite 2, Level 3, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia

    S. Norderval, R. Brouwer & J. O. Keck

  2. 124 Westgarth Street, Fitzroy, VIC, 3065, Australia

    C. Behrenbruch

  3. Department of Gastroenterological Surgery, University Hospital of North Norway, 9038, Tromsö, Norway

    S. Norderval

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  1. S. Norderval
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  2. C. Behrenbruch
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  3. R. Brouwer
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  4. J. O. Keck
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Correspondence to S. Norderval.

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Norderval, S., Behrenbruch, C., Brouwer, R. et al. Efficacy of cyclic sacral nerve stimulation for faecal incontinence. Tech Coloproctol 17, 511–516 (2013). https://doi.org/10.1007/s10151-013-0999-6

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  • DOI: https://doi.org/10.1007/s10151-013-0999-6

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