title: Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS).
abstract: OBJECTIVE
  Two types of neuromodulation are currently practised for the treatment of fecal incontinence (FI): sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). This study compares these therapies, as no data exist to prospectively assess their relative efficacy and costs.
  
  
  METHODS
  The subjects of this study were two distinct cohorts undergoing SNS (between 2003 and 2008) or PTNS (2008-onwards) for FI. Clinical outcomes assessed at 3 months included incontinence scores and the number of weekly incontinence episodes. The direct medical costs for each procedure were calculated from the audited expenditure of our unit.
  
  
  RESULTS
  Thirty-seven patients (94.6 % women) underwent permanent SNS and 146 (87.7 % women) underwent PTNS. The mean pre-treatment incontinence score (± SD) was greater in the SNS cohort (14 ± 4 vs. 12 ± 4) and the mean post-treatment incontinence scores were similar for the two therapies (9 ± 5 vs. 10 ± 4), with a greater effect size evident in the SNS patients. In a 'pseudo case-control' analysis with 37 "matched" patients, the effect of both treatments was similar. The cost of treating a patient for 1 year was £ 11,374 ($ 18,223) for permanent SNS vs. £ 1740 ($ 2784) for PTNS.
  
  
  CONCLUSIONS
  Given the lesser cost and invasive nature of PTNS, where both techniques are available, a trial of PTNS could be considered for all patients.
authors.affiliation: Academic Surgical Unit, National Centre for Bowel Research and Surgical Innovation, Barts Health NHS Trust, London, UK, alex007@doctors.org.uk.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hotouras
authors.forename: Jamie
authors.initials: J
authors.lastname: Murphy
authors.forename: Marion
authors.initials: M
authors.lastname: Allison
authors.forename: Anne
authors.initials: A
authors.lastname: Curry
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D054869:Clinical Audit; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D013979:Tibial Nerve / Q000502:physiology; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult