title: Sacral nerve stimulation for faecal incontinence: medium-term follow-up from a single institution.
abstract: BACKGROUND
  Most studies on sacral nerve stimulation (SNS) are either single-centre with small numbers of patients or multi-centre studies. We present the medium-term follow-up results from a single centre for 127 patients undergoing SNS.
  
  
  METHODS
  Consecutive patients treated with SNS for faecal incontinence had preoperative baseline St Mark's continence scores, faecal incontinence quality of life (FIQL) measures and anorectal physiology studies. Follow-up was a postal questionnaire concerning continence, FIQL, patient-perceived change in bowel control (-5 to +5 where 0 is no change), overall satisfaction (0-10 visual analogue scale) and use of medications.
  
  
  RESULTS
  A total of 166 patients underwent temporary nerve stimulation testing, of which 112 progressed to a permanent implantable pulse generator (IPG). Fifteen received an IPG without the testing phase, hence 127 patients in total. Fourteen had the IPG removed, four were deceased, leaving 109 for assessment; 91 (83%) responded to the survey. Mean follow-up was 2.7 years (range: 2 months-8.5 years). Mean baseline St Mark's continence score was 14.4, and mean follow-up score was 10.3 (P < 0.01). FIQL improved in all domains (P < 0.001). Patient-reported improved bowel control mean score was +3.2 (95% CI: 2.9, 3.55). Median satisfaction score was 8.0 (range: 0-10). Complications included 17 lead dislodgements, seven superficial infections, five infections requiring surgery and five repositioning of a rotated IPG. Thirty-two patients used loperamide and 34 used fibre supplements.
  
  
  CONCLUSIONS
  In this observational study, limited by the absence of a placebo control group, SNS significantly improved continence and quality of life, and patient satisfaction was high.
authors.affiliation: Department of Colorectal Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Patton
authors.affiliation: Department of Colorectal Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Earl
authors.initials: E
authors.lastname: Abraham
authors.affiliation: Department of Colorectal Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: David Z
authors.initials: DZ
authors.lastname: Lubowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000209:etiology* / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012445:Sacrococcygeal Region / Q000294:innervation*; D016896:Treatment Outcome; D014946:Wound Infection / Q000150:complications
keywords: faecal incontinence; sacral nerve stimulation