title: Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence.
abstract: BACKGROUND
  Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence.
  
  
  METHODS
  Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE. The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success.
  
  
  RESULTS
  Fifty-two patients were recruited, of whom 32 (62 per cent) had a successful PNE outcome and 20 (38 per cent) an unsuccessful outcome. The AAR variable opening pressure was significantly greater in patients who subsequently had a successful PNE result compared with the pressure in patients who did not (28 versus 17 cmH2 O; P = 0·008). No difference was seen in the manometric equivalent, maximum resting pressure. Opening pressure was an independent predictor of success with an odds ratio of 1·08 (95 per cent confidence interval 1·01 to 1·16; P = 0·018).
  
  
  CONCLUSIONS
  AAR is a sensitive test of sphincter function and can identify differences between patients who respond to PNE and those who do not. Opening pressure is an independent predictor of success in PNE, and may be of value in the selection of patients for this expensive treatment option.
authors.affiliation: Pelvic Floor Service, Department of General Surgery, University Hospital South Manchester, Manchester, UK.
authors.forename: B R
authors.initials: BR
authors.lastname: Hornung
authors.forename: G L
authors.initials: GL
authors.lastname: Carlson
authors.forename: P J
authors.initials: PJ
authors.lastname: Mitchell
authors.forename: N
authors.initials: N
authors.lastname: Klarskov
authors.forename: G
authors.initials: G
authors.lastname: Lose
authors.forename: K J
authors.initials: KJ
authors.lastname: Telford
authors.forename: E S
authors.initials: ES
authors.lastname: Kiff
mesh_terms: D000162:Acoustics / Q000295:instrumentation; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D012372:ROC Curve; D012044:Regression Analysis; D016896:Treatment Outcome