title: Quality of life is markedly improved in patients with fecal incontinence after sacral nerve stimulation.
abstract: OBJECTIVE
  The aim of the present analysis was to report on the relationship between long-term improvement in quality of life (QOL) and fecal incontinence (FI) severity and long-term reduction in FI episodes after sacral nerve stimulation (SNS) or sacral neuromodulation.
  
  
  METHODS
  Patients who met inclusion/exclusion criteria, and initially had more than 2 FI episodes per week, were offered SNS therapy. Patients with 50% or higher reduction in FI during a 2-week test period were implanted with a neurostimulator (InterStim; Medtronic, Minneapolis, Minn). Assessments were completed by patients at baseline and at 3, 6, and 12 months after implant, and annually thereafter. The present report includes data from the 4-year postimplant follow-up.
  
  
  RESULTS
  A total of 133 patients underwent test stimulation with a 90% success rate, and as a result, 120 (110 females) with a mean age of 60.5 years and a mean duration of FI of 6.8 years received long-term implantation. Of them, 78 patients completed all or part of the 4-year follow-up assessment. Fecal incontinence episodes decreased from a mean of 9.4 per week at baseline to 1.9 per week at 48 months (P < 0.001). The 4-year analyses showed that SNS had a positive and sustained impact on all 4 scales of the Fecal Incontinence Quality of Life questionnaire (P < 0.001), Fecal Incontinence Severity Index scores improved from a mean of 39.9 to 28 (P < 0.001), and self-rated bowel health scores improved from a mean of 3.5 to 6.9 (P < 0.001).
  
  
  CONCLUSIONS
  Sacral nerve stimulation not only restores or improves continence in treated patients with chronic FI but also improves their quality of life and symptom severity.
authors.affiliation: Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, Canada. g.devroede@sympatico.ca
authors.forename: Ghislain
authors.initials: G
authors.lastname: Devroede
authors.forename: Chad
authors.initials: C
authors.lastname: Giese
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
authors.forename: John A
authors.initials: JA
authors.lastname: Coller
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: Tracy
authors.initials: T
authors.lastname: Hull
authors.forename: Katherine
authors.initials: K
authors.lastname: Stromberg
authors.forename: Sudha
authors.initials: S
authors.lastname: Iyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology; D059026:Diagnostic Self Evaluation; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D013995:Time; D016896:Treatment Outcome