title: Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair.
abstract: OBJECTIVE
  Anal sphincter lesions represent the major cause of fecal incontinence, particularly in women. Sphincteroplasty with overlap is the traditional treatment, but a significant reduction in benefits within 5 years of surgery has been reported. More recently, sacral nerve stimulation has been suggested following sphincteroplasty or as primary treatment.
  
  
  METHODS
  Overall, 24 women with fecal incontinence in the presence of anal sphincter lesions underwent sphincteroplasty (14 patients, mean age 47.6 +/- 15.6 years, range 26-70) or definitive implant of sacral nerve stimulation (10 patients, mean age 60.7 +/- 17.6 years, range 26-73), using identical selection criteria. At baseline, patients were studied with clinical evaluation, 3-dimensional endoanal ultrasound, and anorectal manometry (ARM), repeated at follow-up (median 60.0 months, range 6-96 in sphincteroplasty group; median 33.0 months, range 6-84 in sacral nerve stimulation group).
  
  
  RESULTS
  At baseline, both groups presented similar characteristics. Two sphincteroplasty patients (14.3%) experienced relapse of fecal incontinence at 6 and 19 months after treatment, whereas good to excellent continence was observed in all of the sacral nerve stimulation patients. Compared to baseline, both groups showed a significant improvement in clinical parameters, and ARM data remained unchanged. In 12 of 14 sphincteroplasty patients, the repaired sphincter at endoanal ultrasound was found to overlap. At follow-up, comparison between sphincteroplasty and sacral nerve stimulation showed no significant differences in clinical and ARM parameters, if related to lesion of internal, external, or both sphincters.
  
  
  CONCLUSIONS
  These data appear to confirm that sacral nerve stimulation could represent a valid alternative in the treatment of fecal incontinence patients presenting with sphincter lesion that was not preceded by sphincteroplasty.
authors.affiliation: Department of Surgical Sciences, Catholic University, Rome, Italy. carloratto@tiscali.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratto
authors.forename: Francesco
authors.initials: F
authors.lastname: Litta
authors.forename: Angelo
authors.initials: A
authors.lastname: Parello
authors.forename: Lorenza
authors.initials: L
authors.lastname: Donisi
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000000981:diagnostic imaging / Q000502:physiology*; D008365:Manometry; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography