title: Evaluation of the use of posterior tibial nerve stimulation for the treatment of fecal incontinence: preliminary results of a prospective study.
abstract: OBJECTIVE
  Neuromodulation therapies have been used with success in patients with fecal incontinence. Intermittent percutaneous tibial nerve stimulation is a new, minimally invasive treatment option for these patients. This study was designed to evaluate the results of intermittent percutaneous tibial nerve stimulation in patients with fecal incontinence.
  
  
  METHODS
  Sixteen patients (11 females; mean age, 59 +/- 7.9 years) with severe fecal incontinence were treated with percutaneous tibial nerve stimulation. All patients completed a defecation diary, the Wexner Fecal Continence Scale, a fecal incontinence quality-of-life questionnaire, and a visual analog scale before treatment and during each phase of the study. Endoluminal ultrasound and anorectal physiologic studies were also performed in each patient.
  
  
  RESULTS
  Continence was improved in 10 of 16 patients after the first phase. Six patients did not continue to the second phase of treatment because of a lack of initial response. During the second phase, 7 of 16 continued to show improvement. After a six-month period without any treatment, 5 of 16 continued to have good continence. Overall, percutaneous tibial nerve stimulation significantly improved fecal continence. The Wexner score improved from a mean of 13.2 +/- 4.1 at baseline to 9 +/- 5.2 at the end of the first phase (P < 0.0005), to 8 +/- 5.7 at the end of the second phase (P = 0.001), and to 9.1 +/- 5 after 6 months without treatment (P = 0.001). Significant improvement was observed in three main domains of the fecal incontinence quality-of-life scale: coping/behavior, depression, and embarrassment. Scores on the visual analog scale improved from a mean of 4.6 +/- 1.5 at baseline to 7 +/- 2.5 at the end of the first phase (P = 0.002) and to 7.2 +/- 2.5 after 6 months without treatment (P = 0.001).
  
  
  CONCLUSIONS
  Percutaneous tibial nerve stimulation is a minimally invasive and effective treatment option for patients with fecal incontinence.
authors.affiliation: Coloproctology Unit, Department of General Surgery, Hospital Juan Ramón Jiménez, Huelva, Spain. delaportilla@ucphuelva.com
authors.forename: Fernando
authors.initials: F
authors.lastname: de la Portilla
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rada
authors.forename: Juan
authors.initials: J
authors.lastname: Vega
authors.forename: Carmen Almeida
authors.initials: CA
authors.lastname: González
authors.forename: Nieves
authors.initials: N
authors.lastname: Cisneros
authors.forename: Victor Hugo
authors.initials: VH
authors.lastname: Maldonado
mesh_terms: D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013979:Tibial Nerve / Q000502:physiology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014463:Ultrasonography