title: Sacral spinal nerve stimulation for faecal incontinence: multicentre study.
abstract: BACKGROUND
  In patients with faecal incontinence in whom conservative treatment fails, options are limited for those with a functionally deficient but morphologically intact sphincter. We investigated the effect of sacral nerve stimulation on continence and quality of life.
  
  
  METHODS
  In this multicentre prospective trial, 37 patients underwent a test stimulation period, followed by implantation of a neurostimulator for chronic stimulation in 34. Effect on continence was assessed by daily bowel-habit diaries over a 3-week period and on quality of life by the disease-specific American Society of Colon and Rectal Surgeons (ASCRS) questionnaire and the standard short form health survey questionnaire (SF-36). Every patient served as his or her own control.
  
  
  RESULTS
  Frequency of incontinent episodes per week fell (mean 16.4 vs 3.1 and 2.0 at 12 and 24 months; p<0.0001) for both urge and passive incontinence during median follow-up of 23.9 months. Mean number of days per week with incontinent episodes also declined (4.5 vs 1.4 and 1.2 at 12 and 24 months, p<0.0001), as did staining (5.6 vs 2.4 at 12 months; p<0.0001) and pad use (5.9 vs 3.7 at 12 months; p<0.0001). Ability to postpone defecation was enhanced (at 12 months, p<0.0001), and ability to completely empty the bowel was slightly raised during follow-up (at 12 months, p=0.4122). Quality of life improved in all four ASCRS scales (p<0.0001) and in seven of eight SF-36 scales, though only social functioning was significantly improved (p=0.0002).
  
  
  CONCLUSIONS
  Sacral nerve stimulation greatly improves continence and quality of life in selected patients with morphologically intact or repaired sphincter complex offering a treatment for patients in whom treatment options are limited.
authors.affiliation: Department of General Surgery, University Hospital Erlangen, Erlangen, Germany. Klaus.Matzel@chir.imed.uni-erlangen.de
authors.forename: Klaus E
authors.initials: KE
authors.lastname: Matzel
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kamm
authors.forename: Michael
authors.initials: M
authors.lastname: Stösser
authors.forename: Cor G M I
authors.initials: CG
authors.lastname: Baeten
authors.forename: John
authors.initials: J
authors.lastname: Christiansen
authors.forename: Robert
authors.initials: R
authors.lastname: Madoff
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
authors.forename: R John
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: Josep
authors.initials: J
authors.lastname: Rius
authors.forename: Harald
authors.initials: H
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D003672:Defecation; D004558:Electric Stimulation / Q000009:adverse effects; D004567:Electrodes, Implanted / Q000009:adverse effects; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires