Advancement anoplasty and sacral nerve stimulation: an effective combination for radiation-induced anal stenosis.
BACKGROUND
Pelvic radiotherapy can cause anal stenosis. Patients can be left with severe rectal evacuatory difficulties, anal fissuring and resistant faecal incontinence. The management of such patients is difficult since surgical treatment can worsen faecal incontinence.


METHODS
We report a patient who was treated for recurrent fissuring and faecal incontinence secondary to severe anal stenosis caused by external beam radiotherapy to his prostate. A 74-year-old male patient underwent excision of the fissuring, fibrotic anal mucosa and internal sphincter and was then treated with a broad-based House advancement anoplasty. The patient's fissuring was successfully treated but he still suffered from faecal incontinence. The patient underwent sacral nerve stimulation with significant improvement in all faecal incontinence symptoms.


CONCLUSIONS
The use of a novel combination of a House advancement anoplasty and sacral nerve stimulation is a safe and effective treatment rationale for treatment of radiation-induced anal stenosis.
Centre for Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. n.thin@qmul.ac.uk
Noel N
NN
Thin
Emma V
EV
Carrington
Karyn
K
Grimmer
Charles H
CH
Knowles
D000368:Aged; D001003:Anal Canal / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects*; D012447:Sacrum / Q000294:innervation*; D013524:Surgical Flaps; D016896:Treatment Outcome