title: Sacral neuromodulation for bowel dysfunction: a consensus statement from the Italian group.
abstract: BACKGROUND
  Representatives from the Italian centers experienced in sacral neuromodulation (SNM) for the treatment of bowel dysfunction met in order to define the current clinical practice in Italy and to produce a consensus statement regarding indications for this therapy and patient management.
  
  
  METHODS
  Fifty Italian colonproctologists were asked to complete a questionnaire concerning their clinical practice in SNM (290 questions, grouped within 4 broad areas). Physicians expressed their opinion by completing the questionnaire, assigning to each statement their level of agreement according to the 5-point Likert scale; the data were analyzed by attributing to each expert's answers a weight proportional to the degree of experience. During a meeting held 2 months later, the critical aspects of the therapy were re-examined and discussions held with the goal of reaching an agreement on controversial topics. The available literature was reviewed.
  
  
  RESULTS
  Patient selection criteria, etiology, diagnostic investigations, test procedures and implantation, follow-up and evaluation of results have been reviewed. The aim was to achieve an algorithm for patient management, showing the place of SNM in the treatment of bowel dysfunction. The approach in case of treatment failure was also discussed.
  
  
  CONCLUSIONS
  Analysis of the data collected reveals substantial consensus at the national level concerning all the main points with regard to the therapy. The recommendations expressed in this article can be considered as national guidelines and taken into account by the principal international implantation centers.
authors.affiliation: Department of Surgery, Città della Scienza e della Salute, San Giovanni Battista Hospital, Corso Bramante 88, Turin, Italy, ezio.falletto@tin.it.
authors.forename: E
authors.initials: E
authors.lastname: Falletto
authors.forename: E
authors.initials: E
authors.lastname: Ganio
authors.forename: G
authors.initials: G
authors.lastname: Naldini
authors.forename: C
authors.initials: C
authors.lastname: Ratto
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
mesh_terms: D032921:Consensus; D003248:Constipation / Q000628:therapy*; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy; D007558:Italy; D008160:Lumbosacral Plexus; D010818:Practice Patterns, Physicians'; D012447:Sacrum / Q000294:innervation*; D011795:Surveys and Questionnaires; D004561:Transcutaneous Electric Nerve Stimulation
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