Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions.
METHODS
Retrospective study.


OBJECTIVE
Efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord-injured patients (SCIPs) affected by chronic neurogenic bowel symptoms (NBSs).


METHODS
Neurourology Department. Primary to tertiary care.


METHODS
Retrospective non-blinded study without controls. Thirty-nine SCIPs were submitted to temporary stimulation for NBS. Permanent implantation was carried out if both their NBSs improved and the Wexner questionnaire scores were reduced by at least 50% during the first stage compared with that at baseline. Outcome measures included episodes of fecal incontinence and number of evacuations per week, as well as the Wexner score and the Short Form 36 (SF-36) Health Survey questionnaire.


RESULTS
Twenty-three SCIPs were submitted to definitive SNM, maintaining their clinical benefits after permanent implantation with a median follow-up of 38 months. The length of time since neurological diagnosis to SNM therapy represents the only factor related to the success of the implantation, P<0.05. In subjects with constipation (12), the median number of evacuations shifted from 1.65 to 4.98 per week, whereas the Wexner score changed from 19.91 to 6.82 in the final checkup with P<0.05. In subjects with fecal incontinence (11), the median number of episodes per week in the final follow-up was 1.32 compared with 4.55 pre-SNM. The general and mental health of both groups was measured with the SF-36 questionnaire and consistently showed statistical improvement (P<0.05).Anorectal manometry showed no important variation compared with baseline. There were no major complications.


CONCLUSIONS
SNM therapy should be considered for the treatment of NBS for select patients with incomplete spinal cord injury when conservative treatments fail.
Lombardi
G
G
Neuro-Urology Spinal Unit Department, Careggi University Hospital of Florence, Florence 50139, Italy. giuseppelombardi@interfree.it
Del Popolo
G
G
Cecconi
F
F
Surrenti
E
E
Macchiarella
A
A
D000328:Adult; D003248:Constipation / Q000209:etiology / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000209:etiology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome