title: Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence.
abstract: BACKGROUND
  Percutaneous, transcutaneous and sham transcutaneous posterior tibial nerve stimulation was compared in a prospective blinded randomized placebo-controlled trial.
  
  
  METHODS
  Patients who had failed conservative treatment for faecal incontinence were randomized to one of three groups: group 1, percutaneous; group 2, transcutaneous; group 3, sham transcutaneous. Patients in groups 1 and 2 received 30-min sessions of posterior tibial nerve stimulation twice weekly for 6 weeks. In group 3, transcutaneous electrodes were placed in position but no stimulation was delivered. Symptoms were measured at baseline and after 6 weeks using a bowel habit diary and St Mark's continence score. Response to treatment was defined as a reduction of at least 50 per cent in weekly episodes of faecal incontinence compared with baseline.
  
  
  RESULTS
  Thirty patients (28 women) were enrolled. Nine of 11 patients in group 1, five of 11 in group 2 and one of eight in group 3 had a reduction of at least 50 per cent in weekly episodes of faecal incontinence at the end of the 6-week study phase (P = 0·035). Patients undergoing percutaneous nerve stimulation had a greater reduction in the number of incontinence episodes and were able to defer defaecation for a longer interval than those undergoing transcutaneous and sham stimulation. These improvements were maintained over a 6-month follow-up period.
  
  
  CONCLUSIONS
  Posterior tibial nerve stimulation has short-term benefits in treating faecal incontinence. Percutaneous therapy appears to have superior efficacy to stimulation applied by the transcutaneous route.
  
  
  BACKGROUND
  NCT00530933 (http://www.clinicaltrials.gov).
authors.affiliation: Physiology Unit, St Mark's Hospital, Watford Road, Harrow HA1 3UJ, UK. anilthomasgeorge@hotmail.com
authors.forename: A T
authors.initials: AT
authors.lastname: George
authors.forename: K
authors.initials: K
authors.lastname: Kalmar
authors.forename: S
authors.initials: S
authors.lastname: Sala
authors.forename: K
authors.initials: K
authors.lastname: Kopanakis
authors.forename: A
authors.initials: A
authors.lastname: Panarese
authors.forename: T C
authors.initials: TC
authors.lastname: Dudding
authors.forename: J R
authors.initials: JR
authors.lastname: Hollingshead
authors.forename: R J
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: C J
authors.initials: CJ
authors.lastname: Vaizey
mesh_terms: D001003:Anal Canal / Q000502:physiology; D000704:Analysis of Variance; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011312:Pressure; D011446:Prospective Studies; D011788:Quality of Life; D012007:Rectum / Q000502:physiology; D016037:Single-Blind Method; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome