title: Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence.
abstract: BACKGROUND
  Over the past 18 years neuromodulation therapies have gained support as treatments for faecal incontinence (FI); sacral nerve stimulation (SNS) is the most established of these. A systematic review was performed of current evidence regarding the clinical effectiveness of neuromodulation treatments for FI.
  
  
  METHODS
  The review adhered to the PRISMA framework. A comprehensive search of the literature included PubMed, MEDLINE, Embase and Evidence-Based Medicine Reviews. Methodological quality assessment and data extraction were completed in a systematic fashion.
  
  
  RESULTS
  For SNS, 321 citations were identified initially, of which 61 studies were eligible for inclusion. Of studies on other neuromodulation techniques, 11 were eligible for review: seven on percutaneous tibial nerve stimulation (PTNS) and four on transcutaneous tibial nerve stimulation (TTNS). On intention-to-treat, the median (range) success rates for SNS were 63 (33-66), 58 (52-81) and 54 (50-58) per cent in the short, medium and long terms respectively. The success rate for PTNS was 59 per cent at the longest reported follow-up of 12 months. SNS, PTNS and TTNS techniques also resulted in improvements in Cleveland Clinic Incontinence Score and quality-of-life measures. Despite significant use of neuromodulation in treatment of FI, there is still no consensus on outcome reporting in terms of measures used, aetiologies assessed, length of follow-up or assessment standards.
  
  
  CONCLUSIONS
  Emerging data for SNS suggest maintenance of its initial therapeutic effect into the long term. The clinical effectiveness of PTNS is comparable to that of SNS at 12 months, although there is no evidence to support its continued effectiveness after this period. PTNS may be a useful treatment before SNS. The clinical effectiveness of TTNS is still uncertain owing to the paucity of available evidence. A consensus to standardize the use of outcome measures is recommended in order that further reports can be compared meaningfully.
authors.affiliation: National Centre for Bowel Research and Surgical Innovation, London, UK.
authors.forename: N N
authors.initials: NN
authors.lastname: Thin
authors.forename: E J
authors.initials: EJ
authors.lastname: Horrocks
authors.forename: A
authors.initials: A
authors.lastname: Hotouras
authors.forename: S
authors.initials: S
authors.lastname: Palit
authors.forename: M A
authors.initials: MA
authors.lastname: Thaha
authors.forename: C L H
authors.initials: CL
authors.lastname: Chan
authors.forename: K E
authors.initials: KE
authors.lastname: Matzel
authors.forename: C H
authors.initials: CH
authors.lastname: Knowles
mesh_terms: D004567:Electrodes, Implanted / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D008160:Lumbosacral Plexus; D011788:Quality of Life; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome