Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients.
OBJECTIVE
Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI.


METHODS
Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year.


RESULTS
The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome.


CONCLUSIONS
Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.
Gallas
S
S
ADEN EA 3234 ⁄ IFR MP 23, Rouen University Hospital, Grenoble, France.
Michot
F
F
Faucheron
J L
JL
Meurette
G
G
Lehur
P A
PA
Barth
X
X
Damon
H
H
Mion
F
F
Rullier
E
E
Zerbib
F
F
Sielezneff
I
I
Ouaïssi
M
M
Orsoni
P
P
Desfourneaux
V
V
Siproudhis
L
L
Mathonnet
M
M
Menard
J F
JF
Leroi
A M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted / Q000009:adverse effects; D005242:Fecal Incontinence / Q000601:surgery / Q000628:therapy*; D005243:Feces; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011788:Quality of Life; D012044:Regression Analysis; D012445:Sacrococcygeal Region / Q000294:innervation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult