title: Outcome of sacral nerve stimulation for fecal incontinence in patients refractory to percutaneous tibial nerve stimulation.
abstract: BACKGROUND
  Percutaneous tibial nerve stimulation and sacral nerve stimulation are both second-line treatments for fecal incontinence, but the comparative efficacy of the 2 therapies is unknown. In our institution, patients with refractory fecal incontinence are generally treated with percutaneous tibial nerve stimulation before being considered for sacral nerve stimulation.
  
  
  OBJECTIVE
  The aim of this study was to assess the outcome associated with this treatment algorithm in order to guide future management strategies.
  
  
  METHODS
  All patients with fecal incontinence treated over a 3-year period with tibial nerve stimulation before receiving sacral nerve stimulation were identified from a prospectively recorded database. Demographics and pretreatment anorectal physiological data were available for all patients.
  
  
  METHODS
  This study was conducted at an academic colorectal unit in a tertiary center.
  
  
  METHODS
  Twenty patients (17 female:3 male, median age 55 (33-79) years) were identified to be refractory to percutaneous tibial nerve stimulation.
  
  
  METHODS
  Clinical outcome data were collected prospectively before and after treatment, including 1) Cleveland Clinic Florida-Fecal Incontinence scores and 2) number of incontinence episodes per week.
  
  
  RESULTS
  The mean (±SD) pretreatment incontinence score (11.7 ± 3.5) did not differ from the mean incontinence score after 12 sessions of tibial nerve stimulation (10.9 ± 3.6, p = 0.42). All patients were subsequently counseled for sacral nerve stimulation, and 68.4% of them reported a significant therapeutic benefit with an improved incontinence score (7.7 ± 4.1, p = 0.014).
  
  
  CONCLUSIONS
  This was a nonrandomized study with a relatively small number of patients
  
  
  CONCLUSIONS
  Sacral nerve stimulation appears to be an effective treatment for patients who do not gain an adequate therapeutic benefit from percutaneous tibial nerve stimulation and, thus, should be routinely considered for this patient cohort.
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University London, Whitechapel, London, United Kingdom. alex007@doctors.org.uk
authors.forename: Alexander
authors.initials: A
authors.lastname: Hotouras
authors.forename: Jamie
authors.initials: J
authors.lastname: Murphy
authors.forename: Noel N
authors.initials: NN
authors.lastname: Thin
authors.forename: Marion
authors.initials: M
authors.lastname: Allison
authors.forename: Emma
authors.initials: E
authors.lastname: Horrocks
authors.forename: Norman S
authors.initials: NS
authors.lastname: Williams
authors.forename: Charles H
authors.initials: CH
authors.lastname: Knowles
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology*; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013979:Tibial Nerve / Q000502:physiology; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome