title: Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up.
abstract: OBJECTIVE
  The purpose of this study was to evaluate improvement in symptoms of fecal incontinence (FI) in a group of women who also had urinary incontinence (UI) and were successfully implanted with the sacral neuromodulation (SNM) device primarily for urinary incontinence in one US institution.
  
  
  METHODS
  Twenty-four patients with FI and UI who failed to improve with conservative or standard surgical treatment underwent permanent SNM after a successful peripheral nerve stimulation test during 2003-2007. Wexner incontinence score, fecal incontinence quality of life (FIQL), and Bristol stool scales were recorded before and after treatment. Follow-up was done by questionnaires contact.
  
  
  RESULTS
  Twenty-four patients (mean age 56.5 +/- 5.3 years) were studied. The median follow-up was 28 months (range 3-49). Twenty-two patients (92%) were contacted. Seven patients (31.8%) experienced improvement in both urinary and fecal incontinence symptoms. Twelve patients (54.5%) experienced no improvement in FI symptoms after SNM. Four patients required a colostomy or ileostomy; four had the system explanted (two, due to a faded clinical response and two, due to infection); and four other patients experienced no improvement after SNM. The outcomes of ten patients (45.5%) with functioning SNM were reviewed. There were significant improvement of FI symptoms with a significantly lower Wexner score from 12.0 +/- 2.0 before SNM to 4.7 +/- 3.6 (p = 0.009). The mean FIQL scores improved significantly from the baseline score 7.8 +/- 0.8 before SNM to 13.5 +/- 2.6 (p = 0.009). Bristol stool form scale was reduced significantly from 4.5 to 3.5 after SNM (p = 0.02).
  
  
  CONCLUSIONS
  SNM may be beneficial in selected female patients with UI associated with FI. Prospective trials may help delineate which patients will show FI improvement in this combined group.
authors.affiliation: Department of Colorectal Surgery A30, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Galal
authors.initials: G
authors.lastname: El-Gazzaz
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
authors.forename: Levilester
authors.initials: L
authors.lastname: Salcedo
authors.forename: Jeff
authors.initials: J
authors.lastname: Hammel
authors.forename: Raymond
authors.initials: R
authors.lastname: Rackley
authors.forename: Tracy
authors.initials: T
authors.lastname: Hull
mesh_terms: D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012447:Sacrum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000628:therapy*