title: Efficacy of sacral nerve stimulation for the treatment of fecal incontinence.
abstract: BACKGROUND
  Sacral nerve stimulation has been shown to be an effective treatment for fecal incontinence and early studies reported success rates of 67% to 100%. However, "success" has been arbitrarily set at a 50% reduction in symptoms, and data are rarely reported with "intention to treat."
  
  
  OBJECTIVE
  This study aimed to assess the true efficacy of sacral nerve stimulation for fecal incontinence compared with the published literature.
  
  
  METHODS
  This prospective 5-year study was conducted to assess 50 patients with fecal incontinence treated with sacral nerve stimulation. All analyses were performed on an intention-to-treat basis.
  
  
  METHODS
  This study took place in a single tertiary referral colorectal department.
  
  
  METHODS
  Fifty consecutive patients with fecal incontinence refractory to conservative management were included in the study.
  
  
  METHODS
  The interventions performed were temporary evaluation with or without permanent sacral nerve stimulation.
  
  
  METHODS
  : Primary outcome measures were 1) attainment of continence, 2) reduction in fecal incontinence episodes, 3) improvement in Cleveland Clinic Fecal Incontinence scores, and 4) improvement in the ability to defer defecation.
  
  
  RESULTS
  Thirteen patients (26%) did not respond at the temporary evaluation stage or were dissatisfied with the result. Ten further patients (20%) did not achieve a 50% reduction in symptoms following permanent implantation. The median follow-up was 17 months (range, 2-55), at which time 27 patients (54%) experienced a 50% or more reduction in symptoms, including 13 (26%) who achieved apparent continence. Median fecal incontinence episodes per fortnight reduced from 14 (range, 0-53) to 2 (range, 0-20; P < .0001). Median Cleveland Clinic Fecal Incontinence scores reduced from 15 (range, 3-20) to 8 (range, 0-17; P < .0001). The ability to defer defecation improved significantly (P < .0001). These results compare favorably with the published literature.
  
  
  CONCLUSIONS
  Quality of life was not assessed.
  
  
  CONCLUSIONS
  This study demonstrates that sacral nerve stimulation can be an effective treatment for patients with fecal incontinence; however, when analyzed by intention to treat, the symptoms of fecal incontinence continue in the majority (74%) of patients.
authors: Royal London Hospital, Academic Unit of Surgery, Centre for Digestive Diseases, 3rd Floor Alexandra Wing, Barts and The London NHS Trust, Whitechapel, London E1 1BB, United Kingdom. d.boyle@qmul.ac.uk
authors: Derek J
authors: DJ
authors: Boyle
authors: Jamie
authors: J
authors: Murphy
authors: Mayoni L
authors: ML
authors: Gooneratne
authors: Karyn
authors: K
authors: Grimmer
authors: Marion E
authors: ME
authors: Allison
authors: Christopher L H
authors: CL
authors: Chan
authors: Norman S
authors: NS
authors: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008137:Longitudinal Studies; D008160:Lumbosacral Plexus; D008297:Male; D008365:Manometry; D008875:Middle Aged; D020127:Recovery of Function; D012007:Rectum / Q000294:innervation* / Q000503:physiopathology; D016896:Treatment Outcome