title: Predictive factors for successful sacral nerve stimulation in the treatment of fecal incontinence: lessons from a comprehensive treatment assessment.
abstract: BACKGROUND
  Sacral nerve stimulation has a place in the treatment algorithm for fecal incontinence, but the predictive factors of its midterm and long-term success are unknown.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the effect of a 3-year sacral nerve stimulation treatment of fecal continence and to identify specific predictive factors from the pretreatment and per-treatment assessments for the midterm success of sacral nerve stimulation.
  
  
  METHODS
  A cohort analysis of consecutive patients treated with sacral nerve stimulation for fecal incontinence over a period of 3 years was performed.
  
  
  METHODS
  This study was conducted at an academic colorectal unit in a tertiary care center.
  
  
  METHODS
  Sixty patients were available for the assessment of 3-year outcomes.
  
  
  METHODS
  Clinical outcome (including Cleveland Clinic score) and anorectal physiological data were collected prospectively before and after treatment.
  
  
  RESULTS
  At the 3-year follow-up, 33 of the 60 implanted patients had an improved outcome as defined by a ≥30% improvement in the Cleveland Clinic score from baseline (37.1% on intention to treat and 55.0% per protocol), whereas 22 had an unsuccessful outcome as defined by a <30% improvement in the Cleveland Clinic score from baseline (24.7% on intention to treat and 36.7% per protocol), of whom 7 had their device explanted or switched off permanently before the 3-year assessment, and 3 were lost at follow-up. At 3 years, we failed to identify any factors that could predict the 3-year clinical outcome of sacral nerve stimulation based on preimplantation and postimplantation assessments.
  
  
  CONCLUSIONS
  This study involved a relatively small number of patients. There was a lack of consistency in the tool used to evaluate the efficacy of the test and permanent stimulations.
  
  
  CONCLUSIONS
  Based on per-protocol assessments, 55% of the patients had improved outcomes at the 3-year follow-up. No predictor was identified by the pretreatment and posttreatment assessments (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A133).
authors.affiliation: 1Institut National de la Santé et de la Recherche Médicale U1073, Service de Physiologie Digestive, Centre Hospitalier Universitaire de Rouen, Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 0204, Rouen, France 2Institut National de la Santé et de la Recherche Médicale U1073, Service de Chirurgie Digestive, Centre Hospitalier Universitaire de Rouen, Rouen, France 3Unité de Biostatistiques, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Roy
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gourcerol
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Menard
authors.forename: Francis
authors.initials: F
authors.lastname: Michot
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Leroi
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D020878:Device Removal; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators / Q000009:adverse effects; D008160:Lumbosacral Plexus; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012720:Severity of Illness Index