Faecal incontinence in patients with a sphincter defect: comparison of sphincteroplasty and sacral nerve stimulation.
OBJECTIVE
Sphincteroplasty (SP) is used to treat faecal incontinence (FI) in patients with a sphincter defect. Although sacral nerve stimulation (SNS) is used in patients, its outcome in patients with a sphincter defect has not been definitively evaluated. We compared the results of SP and SNS for FI associated with a sphincter defect.


METHODS
Patients treated by SNS or SP for FI with an associated sphincter defect were retrospectively identified from an Institutional Review Board approved prospective database. Patients with ultrasound evidence of a sphincter defect were matched by age, gender and body mass index. The main outcome measure was change in the Cleveland Clinic Florida Faecal Incontinence Score (CCF-FIS).


RESULTS
Twenty-six female patients with a sphincter defect were included in the study. The 13 patients in each group were similar for age, body mass index, initial CCF-FIS and the duration of follow-up. No differences were observed in parity (P = 1.00), the rate of concomitant urinary incontinence (P = 0.62) or early postoperative complications. Within-group analysis showed a significant reduction of the CCF-FIS among patients having SNS (15.9-8.4; P = 0.003) but not SP (16.9-12.9; P = 0.078). There was a trend towards a more significant improvement in CCF-FIS in the SNS than in the SP group (post-treatment CCF-FIS 8.4 vs 12.9, P = 0.06). Net improvement in CCF-FIS was not significantly different between the groups (P = 0.06).


CONCLUSIONS
Significant improvement in CCF-FIS was observed in patients treated with SNS but not SP patients. A trend towards better results was seen with SNS.
Cleveland Clinic Florida, Weston, Florida, USA.|National Council for Scientific and Technological Development (CNPq), Brasilia, Brazil.
F G
FG
Rodrigues
Cleveland Clinic Florida, Weston, Florida, USA.
S A
SA
Chadi
Cleveland Clinic Florida, Weston, Florida, USA.
A J
AJ
Cracco
Cleveland Clinic Florida, Weston, Florida, USA.
D R
DR
Sands
Cleveland Clinic, Cleveland, Ohio, USA.
M
M
Zutshi
Cleveland Clinic, Cleveland, Ohio, USA.
B
B
Gurland
Cleveland Clinic Florida, Weston, Florida, USA.
G
G
Da Silva
Cleveland Clinic Florida, Weston, Florida, USA.
S D
SD
Wexner
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D016208:Databases, Factual; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012447:Sacrum / Q000294:innervation; D012720:Severity of Illness Index; D000074432:Sphincterotomy / Q000379:methods*; D016896:Treatment Outcome
Sacral nerve stimulation; faecal incontinence; sphincter defect; sphincteroplasty