title: A pilot study of chronic pudendal nerve stimulation for faecal incontinence for those who have failed sacral nerve stimulation.
abstract: BACKGROUND
  Sacral nerve stimulation (SNS) is used as a first-line treatment for faecal incontinence when conservative measures have failed. However, one-third of patients fail to benefit from this treatment. We hypothesised that sacral afferent stimulation can be maximised using pudendal nerve stimulation (PNS) and this may be of benefit in this patient group. The aim of this study was to assess chronic PNS for those who failed to improve with SNS.
  
  
  METHODS
  Ten patients who had failed SNS were recruited. All underwent percutaneous insertion of a stimulation lead with four-electrode array adjacent to the pudendal nerve. Continuous bipolar stimulation was administered using an external pulse generator over a 3-week period. Those who experienced a ≥50% reduction in the frequency of incontinent episodes over this period proceeded to chronic stimulation with an implantable pulse generator.
  
  
  RESULTS
  Five patients experienced a ≥50% reduction of incontinent episodes during test stimulation and proceeded to chronic stimulation. In these five patients, at a median (range) follow-up of 24 (6-36) months, the median (inter quartile range) frequency of incontinent episodes reduced from 5 (18.25) to 2.5 (3) per week (p = 0.043). Three patients maintained a ≥50% improvement in soiling. There was an improvement in the St Mark's continence Score from 19 (15-24) to 16 (13-19), p = 0.042. There were no significant changes in ability to defer defecation or in quality of life scores.
  
  
  CONCLUSIONS
  Pudendal nerve stimulation failed to improve the symptoms in the majority of patient who had failed SNS. Only a third experienced any improvement.
authors: The Sir Alan Parks Department of Physiology, St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors: G P
authors: GP
authors: Thomas
authors: A T
authors: AT
authors: George
authors: T C
authors: TC
authors: Dudding
authors: R J
authors: RJ
authors: Nicholls
authors: C J
authors: CJ
authors: Vaizey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology; D003672:Defecation / Q000502:physiology*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D060525:Pudendal Nerve; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult