title: Percutaneous neuromodulation of the posterior tibial nerve for the treatment of faecal incontinence - mid-term results: is retreatment required?
abstract: OBJECTIVE
  Posterior tibial nerve stimulation (PTNS) has emerged in recent years as a therapy for faecal incontinence. Its long-term effectiveness is yet to be established, along with what the form of retreatment should be in the event of loss of effectiveness. The present study aimed to establish the mid-term results to identify the proportion of patients who may need further treatment, and if so when.
  
  
  METHODS
  A prospective study including 30 patients was conducted at an academic hospital. The patients underwent 12 weekly outpatient treatment sessions, each lasting 30 min (first PTNS phase). Neuromodulation was discontinued in those patients who did not have a 40% decrease in their pretreatment Wexner score. Patients having a better than 40% response were offered another 12-week course of complete treatment (second PTNS phase), following which they received no further PTNS treatment (phase without PTNS) but were assessed at 6 months and 2 years.
  
  
  RESULTS
  All patients finished the first phase and 22/30 patients continued to the second phase. During this phase 11 patients showed an improved Wexner score (baseline/first phase/second phase: 14.3 ± 4.2 vs 9.9 ± 5.4 vs 6.8 ± 5.4). After a 6-month period without any treatment, the score was still improved in 11/30 patients (9.1 ± 6.2). At 2 years there was improvement in 16/30 patients (8.8 ± 7.1). There was a significant improvement in three variables of the quality of life questionnaire: lifestyle, coping behaviour and embarrassment.
  
  
  CONCLUSIONS
  The response to first and second phase PTNS was maintained for up to 2 years. Retreatment was not required in about half of patients, even when they had finished the treatment 6 months or 2 years previously.
authors.affiliation: Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: F
authors.initials: F
authors.lastname: de la Portilla
authors.forename: M
authors.initials: M
authors.lastname: Laporte
authors.forename: M V
authors.initials: MV
authors.lastname: Maestre
authors.forename: J M
authors.initials: JM
authors.lastname: Díaz-Pavón
authors.forename: J L
authors.initials: JL
authors.lastname: Gollonet
authors.forename: C
authors.initials: C
authors.lastname: Palacios
authors.forename: J M
authors.initials: JM
authors.lastname: Vázquez-Monchul
authors.forename: A M
authors.initials: AM
authors.lastname: García-Cabrera
authors.forename: R M
authors.initials: RM
authors.lastname: Jiménez-Rodríguez
authors.forename: J M
authors.initials: JM
authors.lastname: Sánchez Gil
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019233:Retreatment; D013979:Tibial Nerve; D016896:Treatment Outcome
keywords: Neuromodulation; faecal incontinence; treatment