title: Dynamic Article: Permanent Sacral Nerve Stimulation Under Local Anesthesia: Feasibility, Best Practice, and Patient Satisfaction.
abstract: BACKGROUND
  The increasing incidence of fecal incontinence and the use of sacral neuromodulation have an increasing impact on health care providers and health care costs.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the technical and clinical success rates, complications, and patient satisfaction of the implantation of permanent sacral nerve stimulation under local anesthesia.
  
  
  METHODS
  A cohort analysis of consecutive patients with sacral nerve stimulation for fecal incontinence over a period of 1 year was performed.
  
  
  METHODS
  This study was conducted at a specialized pelvic floor unit in a tertiary care center.
  
  
  METHODS
  Sixty-one patients were available for the assessment after 1-year follow-up.
  
  
  METHODS
  Technical success, procedural time, and complications were noted. Clinical outcome (including Fecal Incontinence Severity Index, Fecal Incontinence Quality of Life scale, and Gastrointestinal Quality of Life Index were collected prospectively before and after treatment.
  
  
  RESULTS
  All procedures were successfully completed under local anesthesia, with a median total procedural time of 50 minutes (range, 26-72 minutes). All patients were discharged on the day of their procedure. Postoperative complications occurred in 3 patients (4.9%). At 3 months follow-up, the median Fecal Incontinence Severity Index score was reduced from 37 to 27 (p = 0.001). Both the Fecal Incontinence Quality of Life scale and the Gastrointestinal Quality of Life Index had improved from 63 to 82 (p < 0.001) and 72 to 90 (p = 0.012). At a mean follow-up of 13 months, both the Fecal Incontinence Quality of Life scale and the Gastrointestinal Quality of Life Index improved further to 90 (p < 0.001) and 94 (p < 0.001). All patients would recommend the procedure under local anesthesia to other patients. No patients experienced leg pain during follow-up.
  
  
  CONCLUSIONS
  This study involved a relatively small group of patients, and patient satisfaction was only recorded for the last 22 patients. No exact cost calculations were made.
  
  
  CONCLUSIONS
  Permanent sacral nerve stimulation implantation under local anesthesia has high technical and clinical success rates. It is safe, well tolerated by patients, and has obvious logistical and financial benefits.
authors.affiliation: Pelvic Floor Centre, Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Gorissen
authors.forename: Alexander L A
authors.initials: AL
authors.lastname: Bloemendaal
authors.forename: Siriluck
authors.initials: S
authors.lastname: Prapasrivorakul
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Gosselink
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
authors.forename: Roel
authors.initials: R
authors.lastname: Hompes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome