title: Percutaneous tibial nerve stimulation (pTNS): success rate and the role of rectal capacity.
abstract: OBJECTIVE
  Percutaneous tibial nerve stimulation (pTNS) was originally developed to treat urinary incontinence. Recently, some case series have also documented its success in the treatment of fecal incontinence. Nevertheless, the mechanism underlying this effect remains unknown but may be related to changes in rectal capacity. The aim of this study was to investigate the success of pTNS for the treatment of fecal urge incontinence and assess the influence of rectal capacity on treatment efficacy.
  
  
  METHODS
  All patients undergoing pTNS for fecal incontinence between July 2009 and March 2014 were enrolled in a prospective, observational study consisting of a therapeutic regimen that lasted 9 months. Therapy success was defined as a reduction in the CCI (Cleveland Clinic incontinence) score of ≥50% and patient-reported success. Furthermore, quality of life (Rockwood's scale) and changes in anorectal physiology were recorded.
  
  
  RESULTS
  Fifty-seven patients with fecal urge incontinence were eligible, nine of whom were excluded. The success rate was 72.5%. Incontinence events and urge symptoms were significantly reduced after 3 months and at the end of therapy. The median CCI score decreased from 12 to 4 (P < 0.0001), and the quality of life was significantly improved. However, rectal capacity was not significantly related to treatment success before or after therapy. No adverse events were observed.
  
  
  CONCLUSIONS
  These results demonstrate that pTNS can improve the symptoms and quality of life of patients with fecal urge incontinence. However, the study fails to demonstrate a correlation between treatment success and changes in rectal capacity.
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. lukas.marti@kssg.ch.|Department of Surgery, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany. lukas.marti@kssg.ch.
authors.forename: Lukas
authors.identifier: http://orcid.org/0000-0001-5413-132X
authors.initials: L
authors.lastname: Marti
authors.affiliation: Department of Surgery, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Galata
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beutner
authors.affiliation: Department of Surgery, Spital Linth, 8730, Uznach, Switzerland.
authors.forename: Franc
authors.initials: F
authors.lastname: Hetzer
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pipitone
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Katja
authors.initials: K
authors.lastname: Wolff
authors.affiliation: Division of Gastroenterology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Borovicka
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Brunner
authors.affiliation: Division of Gastroenterology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Michael Christian
authors.initials: MC
authors.lastname: Sulz
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Maurus
mesh_terms: D001003:Anal Canal / Q000503:physiopathology; D003672:Defecation; D005242:Fecal Incontinence / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012007:Rectum / Q000503:physiopathology*; D013979:Tibial Nerve / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Fecal incontinence; Neuromodulation; Percutaneous tibial nerve stimulation; Rectal capacity; pTNS