title: Sacral nerve stimulation for intractable constipation.
abstract: OBJECTIVE
  Traditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of sacral nerve stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation).
  
  
  METHODS
  In a prospective study at five European sites patients who failed conservative treatment underwent 21 days test stimulation. Patients with >50% improvement in symptoms underwent permanent neurostimulator implantation. Primary end points were increased defecation frequency, decreased straining and decreased sensation of incomplete evacuation.
  
  
  RESULTS
  62 patients (55 female, median age 40 years) underwent test stimulation, of whom 45 (73%) proceeded to chronic stimulation. 39 (87%) of these 45 patients achieved treatment success. After a median 28 (range 1-55) months follow-up, defecation frequency increased from 2.3 to 6.6 evacuations per week (p<0.001). Days per week with evacuation increased from 2.3 to 4.8 (p<0.001). There was a decrease in time spent toileting (10.5 to 5.7 min, p=0.001), straining (75-46% of successful evacuations, p<0.001), perception of incomplete evacuation (71.5-46% of successful evacuations, p<0.001) and subjective rating of abdominal pain and bloating (p<0.001). Cleveland Clinic constipation score (0=no to 30=severe constipation) decreased from 18 to 10 (p<0.001). Visual analogue scale (VAS) score (0=severe to 100=no symptoms) increased from 8 to 66 (p<0.001). Patients with slow and normal transit benefited. Quality of life significantly improved. Colonic transit normalised in half of those with baseline slow transit (p=0.014).
  
  
  CONCLUSIONS
  SNS is effective in the treatment of idiopathic slow and normal transit constipation resistant to conservative treatment. Clinical Trial Number NCT00200005.
authors.affiliation: University Department of Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, Melbourne 3065, Australia. mkamm@unimelb.edu.au
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kamm
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Dudding
authors.forename: Jarno
authors.initials: J
authors.lastname: Melenhorst
authors.forename: Michael
authors.initials: M
authors.lastname: Jarrett
authors.forename: Zengri
authors.initials: Z
authors.lastname: Wang
authors.forename: Steen
authors.initials: S
authors.lastname: Buntzen
authors.forename: Claes
authors.initials: C
authors.lastname: Johansson
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
authors.forename: Harald
authors.initials: H
authors.lastname: Rosen
authors.forename: Carolynne J
authors.initials: CJ
authors.lastname: Vaizey
authors.forename: Klaus
authors.initials: K
authors.lastname: Matzel
authors.forename: Cor
authors.initials: C
authors.lastname: Baeten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003248:Constipation / Q000503:physiopathology / Q000628:therapy*; D003672:Defecation / Q000502:physiology; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D004812:Epidemiologic Methods; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult