title: Sacral nerve stimulation (SNS), posterior tibial nerve stimulation (PTNS) or acupuncture for the treatment for fecal incontinence: a clinical commentary.
abstract: Sacral nerve stimulation (SNS) has become an established therapy worldwide for the treatment for fecal incontinence. A large number of papers have been published over the years, and SNS is generally considered very effective with improved continence and quality of life for most patients. However, the results are mostly expressed in the semi-quantitative terms, that is, patients' diaries translated into score points. The clinical value of SNS is questionable, especially as the patient groups are usually small and/or etiologically heterogenic and the follow-up period mostly short. The Health Technology Assessment organization in the west region of Sweden has recently evaluated the SNS with regard to evidence, efficacy and risks. Economic and ethical aspects raise serious questions on this expensive and not entirely risk-free treatment in routine medical care. Similar criticism has also been raised by other reviewers proposing a more thorough scientific assessment with well-designed randomized trials and comparison with other similar methods of treatment.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden, ledagus@swipnet.se.
authors.forename: L
authors.initials: L
authors.lastname: Hultén
authors.forename: U
authors.initials: U
authors.lastname: Angerås
authors.forename: M
authors.initials: M
authors.lastname: Scaglia
authors.forename: D
authors.initials: D
authors.lastname: Delbro
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D013979:Tibial Nerve; D016896:Treatment Outcome