title: Short-term outcome of percutaneous tibial nerve stimulation for low anterior resection syndrome: results of a pilot study.
abstract: OBJECTIVE
  Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive procedure which has been demonstrated to be effective in faecal/urinary incontinence but has never been tested in low anterior resection syndrome (LARS). The severity of LARS may be evaluated by the LARS score, but rectal cancer treatments may also affect urinary and sexual function, which are not explored by the LARS score. The Three Axial Perineal Evaluation (TAPE) score is a new validated index addressing the overall pelvic floor functions. This study aims to assess the efficacy of PTNS in LARS patients and to evaluate the results by the LARS and TAPE scores.
  
  
  METHODS
  Twenty-one patients operated on for rectal cancer between 2009 and 2014 complaining of LARS underwent PTNS (12 sessions of 30 min each). Six patients reported urinary incontinence and all except two (men) were sexually inactive. The LARS score and the TAPE score questionnaires were administered at baseline and after 6 months of follow-up.
  
  
  RESULTS
  At 6 months' follow-up, nine patients reported a significant improvement of faecal incontinence and 3/6 an improvement of urinary incontinence after PTNS. Median LARS score significantly decreased from 32 to 27 (P = 0.009), while the median TAPE score improved significantly from 55 to 58 (P = 0.004).
  
  
  CONCLUSIONS
  PTNS may be a further option in the treatment of selected patients with LARS and in addition may improve associated urinary incontinence. The severity of LARS can be detected by the LARS score; however, the adoption of the TAPE score is preferred in the case of concomitant urinary and/or sexual problems not explored by the LARS score.
authors.affiliation: Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy.
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
authors.affiliation: Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Picciariello
authors.affiliation: Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ferrara
authors.affiliation: Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Digennaro
authors.affiliation: Department of Surgery, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Ribas
authors.affiliation: Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: De Fazio
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000294:innervation / Q000503:physiopathology; D059952:Pelvic Floor Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010502:Perineum / Q000503:physiopathology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D013577:Syndrome; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Low anterior resection syndrome; faecal incontinence; obstructed defaecation; pelvic floor function; posterior tibial nerve stimulation; rectal cancer