Dynamic Article: Percutaneous Nerve Evaluation Versus Staged Sacral Nerve Stimulation for Fecal Incontinence.
BACKGROUND
Sacral neuromodulation using a 2-staged approach is an established therapy for fecal incontinence. Office-based percutaneous nerve evaluation is a less-invasive alternative to the stage 1 procedure but is seldom used in the evaluation of patients with fecal incontinence.


OBJECTIVE
The aim of this study was to determine the clinical success of percutaneous nerve evaluation versus a staged approach.


METHODS
This was a retrospective review of a prospectively maintained, single-institution database of patients treated with sacral neuromodulation for fecal incontinence.


METHODS
This study was conducted at a single academic medical center.


METHODS
Eighty-six consecutive patients were treated with sacral neuromodulation for fecal incontinence.


METHODS
Percutaneous nerve evaluation was compared with a staged approach.


METHODS
The primary outcome measured was the proportion of patients progressing to complete implantation based on >50% improvement in Wexner score during the testing phase.


RESULTS
Percutaneous nerve evaluation was performed in 45 patients, whereas 41 underwent a staged approach. The mean baseline Wexner score did not differ between testing groups. Success was similar between the staged approach and percutaneous nerve evaluation (90.2% versus 82.2%; p = 0.36). The mean 3-month Wexner score was not significantly different between testing methods (4.4 versus 4.1; p = 0.74). However, infection was more likely to occur after the staged approach (10.5% versus 0.0%; p < 0.05).


CONCLUSIONS
This study was limited by its retrospective nature and potential for selection bias.


CONCLUSIONS
Percutaneous nerve evaluation offers a viable alternative to a staged approach in the evaluation of patients for sacral neuromodulation in the setting of fecal incontinence. Not only are success rates similar, but percutaneous nerve evaluation also has the benefit of limiting patients to 1 operating room visit and has lower rates of infection as compared with the traditional staged approach for sacral neuromodulation.
1 Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 2 Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio 3 Christ Hospital Center for Pelvic Floor Disorders, Cincinnati, Ohio.
Teresa C
TC
Rice
Yarini
Y
Quezada
Janice F
JF
Rafferty
Ian M
IM
Paquette
D000368:Aged; D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D018579:Patient Selection; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome