title: Long-term outcomes of sacral nerve stimulation for fecal incontinence.
abstract: OBJECTIVE
  In patients with fecal incontinence who do not benefit from medical or behavioral treatments sacral nerve stimulation is now considered a first-line procedure. Although the efficacy of treatment appears to be sustained in the short and medium term, the long-term results of therapy are relatively unknown.
  
  
  OBJECTIVE
  We report the results of chronic sacral nerve stimulation in patients who have had more than 8 years of therapy.
  
  
  METHODS
  All patients who underwent sacral nerve stimulation for fecal incontinence from 1996 to 2002 were followed up prospectively. Data were collected prospectively by the use of bowel habit diaries and St Mark's continence scores. Treatment success was defined as >50% reduction in episodes of fecal incontinence with sacral nerve stimulation in comparison with baseline symptoms.
  
  
  RESULTS
  Between January 1996 and December 2002, 25 patients (male/female 2:23; median age, 54 years (range, 35-68 years) underwent temporary sacral nerve stimulation. Twenty-three (92%) patients had a greater than 50% improvement in their ability to defer defecation during the trial phase and were considered suitable for chronic stimulation. Over a median follow-up of 114 months (range, 96-164 months), full continence was maintained in 12 (48%) of the 23 patients who received a neurostimulator implant. Two patients lost efficacy at 48 and 60 months after permanent implant for unknown reasons and had the device removed. Three patients died at 3, 8, and 9 years after permanent implant because of unrelated comorbidities. Nine patients required a change of battery at a mean (SD) of 87 (13.5) months.
  
  
  CONCLUSIONS
  Sacral nerve stimulation can maintain a persistent clinical benefit in the long term for the majority of patients. Some patients will experience deterioration in their symptoms over time, for reasons yet unknown.
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, London, United Kingdom. anilthomasgeorge@hotmail.com
authors.forename: Anil T
authors.initials: AT
authors.lastname: George
authors.forename: Katalin
authors.initials: K
authors.lastname: Kalmar
authors.forename: Alessandra
authors.initials: A
authors.lastname: Panarese
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Dudding
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: Carolynne J
authors.initials: CJ
authors.lastname: Vaizey
mesh_terms: D000328:Adult; D000368:Aged; D003672:Defecation; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D011788:Quality of Life