title: Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer.
abstract: OBJECTIVE
  Fecal incontinence may occur in patients who have undergone anterior resection for rectal cancer without presenting sphincter lesions. Chemoradiation may contribute to disrupting continence mechanisms. Treatment is controversial. Assessment of fecal incontinence in patients who agreed to integrate treatment for rectal cancer and treatment with sacral neuromodulation are reported.
  
  
  METHODS
  Fecal incontinence following preoperative chemoradiation and anterior resection for rectal cancer was evaluated in four patients. A good response was observed during the percutaneous sacral nerve evaluation test, and so permanent implant of sacral neuromodulation system was performed. Reevaluation was performed at least two months after implant.
  
  
  RESULTS
  After device implantation, the mean fecal incontinence scores decreased, and the mean number of incontinence episodes dropped from 12.0 to 2.5 per week (P < 0.05). Permanent implant resulted in a significant improvement in fecal continence in three patients, and incontinence was slightly reduced in the fourth. Manometric parameters agreed with clinical results: maximum and mean resting tone and the squeeze pressure were normal in three patients and reduced in one. In these same three patients, neorectal sensation parameters increased when the preoperative value was normal or below normal and decreased when the preoperative value was higher than normal, whereas in one patient in whom extremely low values were recorded all of the parameters decreased significantly.
  
  
  CONCLUSIONS
  Fecal incontinence following anterior resection and neoadjuvant therapy should be carefully evaluated. If a suspected neurogenic pathogenesis is confirmed, sacral neuromodulation may be proposed. If the test results are positive, permanent implant is advisable. Failure of this approach does not exclude the use of other, more aggressive treatment.
authors.affiliation: Department of Clinica Chirurgica, Catholic University, 00168 Rome, Italy. carloratto@tiscali.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratto
authors.forename: Egizia
authors.initials: E
authors.lastname: Grillo
authors.forename: Angelo
authors.initials: A
authors.lastname: Parello
authors.forename: Maria
authors.initials: M
authors.lastname: Petrolino
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D004576:Electromyography / Q000379:methods; D019160:Endosonography; D005242:Fecal Incontinence / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology