title: Postoperative issues of sacral nerve stimulation for fecal incontinence and constipation: a systematic literature review and treatment guideline.
abstract: BACKGROUND
  There is a lack of knowledge on the incidence and management of suboptimal therapeutic effect and the complications associated with sacral nerve stimulation for fecal incontinence and constipation.
  
  
  OBJECTIVE
  This study aimed to review current literature on postoperative issues and to propose a treatment algorithm.
  
  
  METHODS
  PubMed, MEDLINE, and EMBASE were searched using the keywords "sacral nerve stimulation," "sacral neuromodulation," "fecal incontinence," and "constipation" for English-language articles published from January 1980 to August 2010. A further search was conducted on a wider literature using the keywords "complication," "adverse effect," "treatment failure," "equipment failure," "infection," "foreign-body migration," "reoperation," "pain," and "algorithm."
  
  
  METHODS
  Four hundred sixty-one titles were identified, and after a title and abstract review, 135 were subjected to full article review; 89 were finally included in this review. Five articles were added by manual search and consensus.
  
  
  RESULTS
  Forty-eight studies were identified as cohort studies reporting on postoperative issues, including 1661 patients who underwent percutaneous nerve evaluation and 1600 patients who proceeded to sacral nerve stimulation therapy. Pooled data showed that the most common problem during percutaneous nerve evaluation was lead displacement (5.3%). The incidence of suboptimal outcome, pain, and infection after implantation was 12.1%, 13.0%, and 3.9%.
  
  
  CONCLUSIONS
  There was significant underreporting of untoward events, because 60% of the studies did not report complications during percutaneous nerve evaluation, and suboptimal outcome after implantation was not disclosed in 44% of the studies.
  
  
  CONCLUSIONS
  The incidence of untoward events associated with sacral nerve stimulation appears to be low. However, there is a significant underreporting of the incidence. Using the information from the structured and systematic literature review, we formulated a clinically relevant guideline for reporting and managing postoperative issues. The guideline can provide a framework for clinical practice.
authors: Sir Alan Parks Physiology Unit, St. Mark's Hospital, Harrow, United Kingdom. yazmaeda@gmail.com
authors: Yasuko
authors: Y
authors: Maeda
authors: Klaus
authors: K
authors: Matzel
authors: Lilli
authors: L
authors: Lundby
authors: Steen
authors: S
authors: Buntzen
authors: Søren
authors: S
authors: Laurberg
mesh_terms: D000465:Algorithms; D003248:Constipation / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D008160:Lumbosacral Plexus; D017410:Practice Guidelines as Topic