Sacral spinal nerve stimulation for faecal incontinence: multicentre study.
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.
Matzel
Klaus E
KE
Department of General Surgery, University Hospital Erlangen, Erlangen, Germany. Klaus.Matzel@chir.imed.uni-erlangen.de
Kamm
Michael A
MA
Stösser
Michael
M
Baeten
Cor G M I
CG
Christiansen
John
J
Madoff
Robert
R
Mellgren
Anders
A
Nicholls
R John
RJ
Rius
Josep
J
Rosen
Harald
H
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