title: Percutaneous peripheral neuromodulation in the treatment of fecal incontinence.
abstract: OBJECTIVE
  To assess the results of peripheral neuromodulation for the treatment of fecal incontinence (FI) resulting from uninhibited rectal contraction (URC) or uninhibited anal sphincter relaxation (UASR).
  
  
  METHODS
  The work comprised 32 patients (age 38.2 +/- 6.7 years; 22 women) with FI in whom conventional therapy had failed before enrollment in the study. Twenty-six had URC and 6 UASR. Peripheral neurostimulation was effected by posterior tibial nerve stimulation using a Stoller Afferent Nerve Stimulator (UroSurge, Coralville, lowa, USA). The needle was introduced into the skin cephalad to the medial malleolus. Stimulation (parameters: 0.5-10 mA, 200 micros, 20 Hz) was performed every other day for 4 weeks. Functional assessment was done by a questionnaire (incontinence score: 0-20) and physiologic studies.
  
  
  RESULTS
  Group 1: 17 patients (13 URC, 4 UASR) had FI improvement, recording a mean score of 1.7 of 20. Group 2: 10 patients (8 URC, 2 UASR) had fair improvement (score 8.6). Group 3: 5 patients had poor results (score 14.8). Rectometric recording showed improvement in groups 1 and 2. Recurrence of symptoms occurred in 8 patients; 6 improved after retreatment.
  
  
  CONCLUSIONS
  A percutaneous access to the S(3) spinal region was achieved through the posterior tibial nerve. Improvement of FI was achieved in 78.2%. The technique is simple, easy, without complications and cost-effective. It can be done as an outpatient procedure or by the patient at home. The results need to be reproduced on a large number of patients.
authors.affiliation: Department of Surgery, Faculty of Medicine, Cairo University, Egypt. ashafik@ahmedshafik.org
authors.forename: A
authors.initials: A
authors.lastname: Shafik
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.forename: O
authors.initials: O
authors.lastname: El-Sibai
authors.forename: R M
authors.initials: RM
authors.lastname: Mostafa
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000294:innervation* / Q000502:physiology*; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D009126:Muscle Relaxation; D012008:Recurrence; D013979:Tibial Nerve / Q000502:physiology