Skip to main content
SpringerLink
Log in

Chronic sacral spinal nerve stimulation for fecal incontinence: Long-term results with foramen and cuff electrodes

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for patients with severe fecal incontinence owing to functional deficits of the external anal sphincter. It aims to use the morphologically intact anatomy to recruit residual function. This study evaluates the long-term results of the first patients treated with this novel approach applying two techniques of sacral spinal nerve stimulator implantation. METHODS: Six patients underwent either of two techniques for electrode placement: one “closed” (electrodes placed through the sacral foramen) and one “open” (cuff electrodes placed after sacral laminectomy). Follow-up evaluation of their continence status ranged from 5 to 66 months. RESULTS: Incontinence improved in all patients. The percentage of incontinent bowel movements decreased during chronic stimulation from a mean of 40.2 percent to 2.8 percent, and the Wexner score decreased from a mean of 17 to 2. The function of the striated anal sphincter improved during chronic stimulation: maximum squeeze pressure increased from a mean of 48.5 mmHg to 92.7 mmHg, and median squeeze pressure increased from a mean of 37.3 mmHg to 72.5 mmHg. No complications were encountered perioperatively or postoperatively. Two devices had to be removed because of intractable pain, in one patient at the site of the electrode after five months and in the other at the site of the impulse generator after 45 months. CONCLUSION: Long-term sacral spinal nerve stimulation persistently improves continence and increases striated anal sphincter function in patients with fecal incontinence owing to functional deficits, but in whom the striated anal sphincter is morphologically intact. Two different operative approaches can be applied effectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Londono-Schimmer EE, Garcia-Duperly R, Nicholls RJ, Ritchie JK, Hawley PR, Thompson JP. Overlapping anal sphincter repair for fecal incontinence due to sphincter trauma: five year follow-up functional results. Int J Colorectal Dis 1993;9:110–3.

    Article  Google Scholar 

  2. Pickrell KL, Broadbent R, Masters FW, Metzger JT. Construction of a rectal spincter and restoration of anal continence by transplanting the gracilis muscle: a report of four cases in children. Ann Surg 1952;135:853–62.

    PubMed  Google Scholar 

  3. Corman ML. Gracilis muscle transposition for anal incontinence: late results. Br J Surg 1985;72(Suppl):S21–2.

    PubMed  Google Scholar 

  4. Baeten CG, Geerdes BP, Adang EM,et al. Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med 1995;332:1600–5.

    Article  PubMed  Google Scholar 

  5. Christiansen J, Lorentzen M. Implantation of artificial sphincter for anal incontinence: report of five cases. Dis Colon Rectum 1989;32:432–6.

    PubMed  Google Scholar 

  6. Christiansen J, Rasmussen O, Lindorff-Larsen K. Long-term results of artificial anal sphincter implantation for severe anal incontinence. Ann Surg 1999;230:45–8.

    Article  PubMed  Google Scholar 

  7. Caldwell KP. The electrical control of sphincter incompetence. Lancet 1963;2:174–5.

    Article  Google Scholar 

  8. Caldwell KP, Cook P, Flack F, James E. Stress incontinence in females: report on 31 cases treated by electrical implant. J Obstet Gynaecol Br Commonwealth 1978;75:777–80.

    Google Scholar 

  9. Stanton S, Edwards L. Treatment of pediatric urinary incontinence by stimulator implant. Br J Urol 1973;45:508–14.

    PubMed  Google Scholar 

  10. Riddle PR, Hill DW, Wallace DM. Electronic techniques for the control of adult urinary incontinence. Br J Urol 1969;41:205–10.

    PubMed  Google Scholar 

  11. Schmidt RA, Senn E, Tanagho EA. Functional evaluation of sacral nerve root integrity—report of a technique. Urology 1990;35:388–92.

    Article  PubMed  Google Scholar 

  12. Schmidt RA. Applications of neurostimulation in urology. Neurourol Urodyn 1988;7:585–92.

    Google Scholar 

  13. Thon WF, Baskin LS, Jonas U, Tanagho EA, Schmidt RA. Surgical principles of sacral foramen electrode implantation. World J Urol 1991;9:138–41.

    Google Scholar 

  14. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation for the treatment of faecal incontinence. Lancet 1995;346:1124–7.

    Article  PubMed  Google Scholar 

  15. Percy JP, Swash M, Neill ME, Parks AG. Electrophysiological study of motor nerve supply of pelvic floor. Lancet 1980;1:16–7.

    PubMed  Google Scholar 

  16. Matzel KE, Schmidt RA, Tanagho EA. Neuroanatomy of the striated muscular anal continence mechanism: implications for the use of neurostimulation. Dis Colon Rectum 1990;33:666–73.

    PubMed  Google Scholar 

  17. Matzel KE, Stadelmaier U, Gall FP. Direkte Elektrostimulation der sakralen Spinalnerven im Rahmen der anorektalen Funktionsdiagnostik. Langenbecks Arch Chir 1995;380:184–8.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  19. Hohenfellner M, Matzel KE, Schultz-Lampel D,et al. Sacral neuromodulation for treatment of micturition disorders and fecal incontinence. In: Hohenfellner R, Novick A, Fichtner J, eds. Innovations in urologic surgery. 2nd ed. Oxford: Isis Medical Media, 1997:129–38.

    Google Scholar 

  20. Brindley GS, Caggs MD. A technique for anodally blocking large nerve fibres through chronically implanted electrodes. J Neurol Neurosurg Psychiatry 1980;43:1083–90.

    PubMed  Google Scholar 

  21. Garten S. Elektroden fuer besondere Zwecke. In: Tigerstedt R, ed. Handbuch der physiologischen Methodik. Leipzig: S. Hirzel, 1911:339–40.

    Google Scholar 

  22. Hohenfellner M, Schultz-Hampel D, Dahms S, Matzel K, Thüroff JW. Chronic bilateral sacral neuromodulation for lower urinary tract dysfunction. J Urol 1998;160:821–4.

    Article  PubMed  Google Scholar 

  23. Porter JA, Salvati EP, Rubin RJ, Eisenstat TE. Complications of colostomies. Dis Colon Rectum 1989;32:299–303.

    PubMed  Google Scholar 

  24. Konsten J, Baeten CG, Spaans F, Havenith MG, Soeters PB. Follow-up of anal dynamic graciloplasty for fecal incontinence. World J Surg 1993;17:404–8.

    Article  PubMed  Google Scholar 

  25. Geerdes BP, Heineman E, Konsten J, Soeters PB, Baeten CG. Dynamic graciloplasty: complications and management. Dis Colon Rectum 1996;39:912–7.

    Article  PubMed  Google Scholar 

  26. Lehur PA, Michot F, Denis P,et al. Results of artificial sphincter in severe anal incontinence: report of 14 consecutive implantations. Dis Colon Rectum 1996;39:1352–5.

    Article  PubMed  Google Scholar 

  27. Malouf A, Vaizey C, Nicholls R, Kamm M. Results of permanent sacral nerve stimulation for fecal incontinence [abstract]. Dis Colon Rectum 1999;42:A12.

    Google Scholar 

  28. Rosen HR, Novi G, Urbarz C, Schiessel R. Sakrale Nervenstimulation (SNS) als Therapie der faekalen Inkontinenz [abstract]. Z Gastroenterol 1999;37:532.

    Google Scholar 

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

    PubMed  Google Scholar 

  30. Vaizey CJ, Kamm M, Turner IC, Nicholls RJ, Woloszko J. Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 1999;44:407–12.

    PubMed  Google Scholar 

  31. Bazeed MA, Thueroff JW, Schmidt RA, Wiggia DM, Tanagho EA. Effect of chronic electrostimulation of the sacral roots on the striated urethral sphincter. J Urol 1982;128:1357–62.

    PubMed  Google Scholar 

  32. Saloms S, Hendriksson J. The adaptive response of skeletal muscle to increased use. Muscle Nerve 1981;4:94–105.

    Article  PubMed  Google Scholar 

  33. Pette D, Vrbova G. Adaption of mammalian skeletal muscle fibers to chronic electrical stimulation. Rev Physiol Biochem Pharmacol 1992;120:116–202.

    Google Scholar 

  34. Beersiek F, Parks AG, Swash M. Pathogenesis of anorectal incontinence. A histometric study of the anal sphincter musculature. J Neurol Sci 1979;42:111–27.

    Article  PubMed  Google Scholar 

  35. Schroeder HD, Reske-Nielsen E. Fiber types in the striated urethral and anal sphincters. Acta Neuropathol (Berl) 1983;60:278–82.

    Article  Google Scholar 

  36. Lierse W, Holschneider AM, Steinfeld J. The relative proportion of type I and type II muscle fibers in the external anal sphincter ani at different ages and stages of development—observation on the development of continence. Eur J Pediatr Surg 1993;3:28–32.

    Google Scholar 

  37. Konsten J, Baeten CG, Havenith MG, Soeters PB. Morphology of dynamic graciloplasty compared with the anal sphincter. Dis Colon Rectum 1993;36:559–63.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Department of Surgery, University of Erlangen-Nürnberg, Erlangen

    Klaus E. Matzel M.D., Ph.D., Uwe Stadelmaier M.D. & Werner Hohenberger M.D., Prof.

  2. Department of Urology, University of Mainz, Mainz, Germany

    Markus Hohenfellner M.D., Ph.D.

Authors
  1. Klaus E. Matzel M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uwe Stadelmaier M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Markus Hohenfellner M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Werner Hohenberger M.D., Prof.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by grants from Bayerischen Chirurgen e.V., Munich, Germany; Wilhelm Sander Stiftung, Neustadt, Germany; and Bakken Research Center, Medtronic, Maastricht, the Netherlands.

A preliminary report of this study was presented as a poster at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.

About this article

Cite this article

Matzel, K.E., Stadelmaier, U., Hohenfellner, M. et al. Chronic sacral spinal nerve stimulation for fecal incontinence: Long-term results with foramen and cuff electrodes. Dis Colon Rectum 44, 59–66 (2001). https://doi.org/10.1007/BF02234822

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02234822

Key words

Search

Navigation