title: Posterior tibial nerve stimulation for fecal incontinence: where are we?
abstract: Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures. Sacral nerve stimulation (SNS) is the main form of neurostimulation that is in use today. Posterior tibial nerve stimulation (PTNS)--both the percutaneous and the transcutaneous routes--remains a relatively new entry in neurostimulation. Though in its infancy, PTNS holds promise to be an effective, patient friendly, safe and cheap treatment. However, presently PTNS only appears to have a minor role with SNS having the limelight in treating patients with faecal incontinence. This seems to have arisen as the strong, uniform and evidence based data on SNS remains to have been unchallenged yet by the weak, disjointed and unsupported evidence for both percutaneous and transcutaneous PTNS. The use of PTNS is slowly gaining acceptance. However, several questions remain unanswered in the delivery of PTNS. These have raised dilemmas which as long as they remain unsolved can considerably weaken the argument that PTNS could offer a viable alternative to SNS. This paper reviews available information on PTNS and focuses on these dilemmas in the light of existing evidence.
authors.affiliation: Anil Thomas George, Colorectal Surgery, St Mark's Hospital, London HA1 3UJ, United Kingdom.
authors.forename: Anil Thomas
authors.initials: AT
authors.lastname: George
authors.affiliation: Anil Thomas George, Colorectal Surgery, St Mark's Hospital, London HA1 3UJ, United Kingdom.
authors.forename: Rudra Krishna
authors.initials: RK
authors.lastname: Maitra
authors.affiliation: Anil Thomas George, Colorectal Surgery, St Mark's Hospital, London HA1 3UJ, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Maxwell-Armstrong
mesh_terms: D003672:Defecation; D005242:Fecal Incontinence / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007422:Intestines / Q000294:innervation*; D020127:Recovery of Function; D013979:Tibial Nerve / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome
keywords: Efficacy of treatment; Faecal incontinence; Neurostimulation; Percutaneous; Posterior tibial nerve stimulation; Transcutaneous