title: Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse?
abstract: BACKGROUND
  High-grade internal rectal prolapse appears to be one of the contributing factors in the multifactorial origin of faecal incontinence. Whether it affects the outcome of sacral neuromodulation is unknown. We compared the functional results of sacral neuromodulation for faecal incontinence in patients with and without a high-grade internal rectal prolapse.
  
  
  METHODS
  One hundred six consecutive patients suffering from faecal incontinence, who were eligible for sacral neuromodulation between 2009 and 2012, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and ultrasound. Symptoms were assessed preoperatively and at 12 months after operation using a standardized questionnaire incorporating the Faecal Incontinence Severity Index (FISI range = 0-61) and the Gastrointestinal Quality of Life Index (GIQLI). Success was defined as a decrease in the FISI score of 50 % or more.
  
  
  RESULTS
  High-grade internal rectal prolapse (HIRP) was found in 36 patients (34%). The patient characteristics were similar in both groups. Temporary test stimulation was successful in 60 patients without HIRP (86%) and in 25 patients with HIRP (69 %) (p = 0.03). A permanent pulse generator was then implanted on these patients. After 1-year follow-up, the median FISI was reduced in patients without HIRP from 37 to 23 (p < 0.01). No significant change in FISI score was observed in patients with a HIRP (FISI, 38 to 34; p = 0.16). Quality of life (GIQLI) was only improved in patients without HIRP. A successful outcome per protocol was achieved in 31 patients without HIRP (52%) versus 4 patients with HIRP (16%) (p < 0.01).
  
  
  CONCLUSIONS
  The presence of a high-grade internal rectal prolapse has a detrimental effect on sacral neuromodulation for faecal incontinence.
authors.affiliation: Oxford Pelvic Floor Centre, Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, OX3 7LJ, UK.
authors.forename: Siriluck
authors.initials: S
authors.lastname: Prapasrivorakul
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Gosselink
authors.forename: Martijn
authors.initials: M
authors.lastname: Gosselink
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Gorissen
authors.forename: Simona
authors.initials: S
authors.lastname: Fourie
authors.forename: Roel
authors.initials: R
authors.lastname: Hompes
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Jones
authors.forename: Chris
authors.initials: C
authors.lastname: Cunningham
authors.forename: Ian
authors.initials: I
authors.lastname: Lindsey
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications*; D012307:Risk Factors; D012447:Sacrum / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult