Sacral nerve modulation for patients with fecal incontinence: long-term outcome and effects on sexual function (original) (raw)

Long-term Efficacy and Safety of Sacral Nerve Stimulation for Fecal Incontinence

Diseases of the Colon & Rectum, 2011

Sacral nerve stimulation is effective in the treatment of urinary incontinence and is currently under Food and Drug Administration review in the United States for fecal incontinence. Previous reports have focused primarily on short-term results of sacral nerve stimulation for fecal incontinence. The present study reports the long-term effectiveness and safety of sacral nerve stimulation for fecal incontinence in a large prospective multicenter study.

Sacral neuromodulation for intractable urge incontinence: Are there factors associated with cure?

Urology, 2005

Objectives. To determine the variables that affect the cure rate in patients with urge incontinence treated with sacral neuromodulation. Methods. This prospective analysis of patients with refractory urinary urge incontinence who underwent placement of a neuromodulator lead and generator was undertaken between October 2000 and December 2003. Quantitative assessment of the severity of their urinary leakage was assessed by preoperative and postoperative 3-day bladder diaries documenting leakage episodes, number of pads used per day, and a 24-hour pad weight assessment. Cure was defined as no daily leakage episodes after permanent implantation. Subjective outcome was assessed using the Incontinence Impact Questionnaire. Two-sample independent t tests, two-way chi-square tests, and tests of two proportions were performed when appropriate, with P Ͻ0.05 considered significant. Results. The mean postimplantation follow-up was 29 months, and the average age was 60 years (range 29 to 83). The cure rate was associated with age, with individuals younger than 55 years having a statistically significant greater cure rate (65% versus 37% for older individuals; P Ͻ0.05). Having three or more chronic conditions was associated with a lower cure rate in both younger and older individuals. Patients with a neurologic condition also had a lower cure rate, but no specific neurologic condition was associated. Conclusions. Age older than 55 years and more than three chronic conditions were independent factors associated with a lower cure rate in patients implanted with a sacral neuromodulator for refractory urge incontinence. A neurologic condition may be associated with a decrease in the cure rate.

Effects of Sacral Neuromodulation on Urinary and Fecal Incontinence

2015

BACKGROUND Fecal incontinence is defined as involuntary passage of stool through the anus. It may vary from soiling to complete evacuation. This involuntary loss of feces, flatus or urge incontinence adversely affects quality of life. Urinary urge incontinence is characterized by symptoms of frequency, urgency and urge incontinence (either alone or in combination). Urgency frequency syndrome is defined as symptoms of frequency and urgency without incontinence episodes. OBJECTIVES To evaluate the efficacy of sacral neuromodulation on these pathologies. METHODS Following a detailed investigation, 51 patients with either urinary or fecal incontinence, or both, who did not respond to medical and behavioral treatment were offered the temporary implant. Of the 51 patients 40 showed improvement and advanced for a permanent device. RESULTS After a mean follow-up of 5 years (range 1-8), there was a significant reduction in the number of incontinence episodes (P < 0.0001), and the number o...

Fecal incontinence treated by sacral neuromodulation: Long-term follow-up of 325 patients

Surgery, 2017

Background. Long-term results of large patient cohorts with fecal incontinence treated by sacral neuromodulation are limited. This study shows the long-term results after a mean follow-up of 7.1 years in 325 patients with fecal incontinence treated by continuous sacral neuromodulation. Methods. All patients with fecal incontinence and eligible for sacral neuromodulation between 2000 and 2015 were evaluated retrospectively. Primary outcome was a decrease in episodes of fecal incontinence, which was defined as involuntary fecal loss at least once per week and documented by a 3 week bowel habit diary. Quality of life was assessed using the Short-Form 36 and the Fecal Incontinence Quality of Life Score. Results. In the study, 374 patients were included for sacral neuromodulation screening and 325 patients (32 male, 9.7%) received permanent, continuous sacral neuromodulation. Mean age was 56.5 years (17-82 years) and mean follow-up was 7.1 years (3.0-183.4 months). In the 325 patients with permanent sacral neuromodulation, fecal incontinence episodes decreased from a mean of 16.1 ± 14.5 to 3.0 ± 3.7 per 3-week period after sacral neuromodulation (P < .001) according to the bowel habit diary. Sacral neuromodulation was removed due to unsatisfactory results in 81 patients. Quality of life (both Short-Form 36 and Fecal Incontinence Quality of Life Score) showed no significant difference compared with the Dutch population during follow-up. Conclusion. Long-term efficacy of sacral neuromodulation can be maintained in about half (52.7%) of all patients screened with sacral neuromodulation for fecal incontinence after a mean follow-up of 7.1 years. Importantly, the quality of life of patients with sacral neuromodulation for fecal incontinence did not differ from the general population. (Surgery 2016;j:j-j.

Long-Term Outcome of Sacral Nerve Stimulation for Fecal Incontinence

Diseases of the Colon & Rectum, 2009

Objective: Sacral nerve stimulation (SNS) has become the first line treatment for fecal incontinence (FI) in the past decade. The purpose of the study is to evaluate the long term outcome of 18 years. The studied patient population represents the one with the longest follow up worldwide. Methods: From 1994 to 2012, 114 patients underwent permanent stimulation. Of these 73 patients with active SNS with a median follow up of 62 months (range 6-224) were available for the study. Prospectively obtained data on functional outcomes, including symptom of FI, incontinence severity score, quality of life, adverse events were monitored applying established methods evaluation. Patients' satisfaction was assessed at the end of the follow up using visual analog scales (VAS). Results: Significant improvements were observed in each aspect of functional outcomes once the treatment sustaining up to 18 years. The mean weekly FI episodes, soiling and pad usage decreased from 11.2, 4.1 and 5.7 at baseline to 3.4, 2.1 and 4.1 at the endpoint. The CCIS score decreased from 15 to 10. Significant improvement of QOL was observed in 4 of 8 scales of SF-36 (social function, vitality, role physical and mental health) and all the 4 scales of FI-QOL in lifestyle, coping/behavior, embarrassment, depression/ perception. The mean scores of VAS satisfaction (ranged 0-10) was 7.5 with 90% patients reported a score ≥ 5 and 61% patients reported a scores ≥8. The overall successful rate SNS was 75% (55/73) with 43% (32/73) were full continence. 85.2% (46/54) and 72.2% (13/18) of patients who were implanted at least 5 years and 10 years ago continued to use SNS. No predictor of success was found in patient demographics, surgical approaches and baseline status. No severe complication or mortality was observed throughout the past 18 years. 33.3% (38/114) patients reported a total of 50 case of surgical intervention-required post implantation events while most of (76%, 38/50) them were maintainable: anticipated battery depletion (14%), pain (12%), sudden lost efficacy (8%) and infection (5%). Conclusion: SNS is an effective treatment for fecal incontinence with pronounced long-term therapeutic result sustained up to nearly 2 decades. The treatment can be maintained in the majority of patients. Patient satisfaction is high. Abstrakt: Ziel: Die sakrale Spinalnervstimulation (SNS) hat sich im letzten Jahrzehnt zur Therapie der Wahl bei Stuhlinkontinenz entwickelt. Inhalt vorliegender Untersuchung ist die Evaluation der Langzeitergebnisse. Die untersuchte Patientengruppe ist die mit dem weltweit längsten Follow-up. Methoden: Von 1994 bis 2012, wurden 114 Patienten mit einem permanenten Nervenstimulationssystem versorgt. 73 Patienten mit aktiver SNS konnten nachverfolgt werden. Das mediane Follow-up beträgt 62 Monate (Range 6-224). Prospektiv erhobene Daten zum funktionellen Ergebnis-einschließlich Inkontinenz Score (CCIS), Inkontinenzschweregrad, Lebensqualität (QoL)-und Nebenwirkungen wurden unter Verwendung etablierter Evaluationsmethoden ausgewertet. Die Patientenzufriedenheit zum Endpunkt der Nachbeobachtung wurde mittels visueller Analogskala (VAS) ermittelt. Ergebnisse: Signifikante Verbesserungen wurden im Hinblick auf jeden Aspekt der funktionellen Ergebnisse bis zu 18 Jahren nachgewiesen. Die durchschnittliche Anzahl von Inkontinenzepisoden, Stuhlschmieren und Vorlagenverwendung sank von 11.2, 4.1 und 5.7 vor Behandlung auf 3.4, 2.1 und 4.1 zum Ende der Nachbeobachtung. Der CCIS-Score sank von 15 auf 10. Signifikante Verbesserungen der QOL fanden sich in 4 von 8 Kategorien des SF-36 (social function, vitality, role physical und mental health) und in allen 4 Kategorien des krankheitspezifischen FI-QOL (lifestyle, coping/behavior, embarrassment, depression/perception). Die durchschnittliche Patientenzufriedenheit (VAS, min:0-max:10) war 7.5; 90% der Patienten bewerteten sie mit einem Score ≥ 5 und 61% der Patienten mit einem Score ≥8. Die Gesamterfolgsrate der SNS war 75% (55/73); 43% (32/73) der Patienten erreichten vollständige Kontinenz. 85.2% (46/54) und 72.2% (13/18) der Patienten, die vor mindestens 5 Jahren bzw. 10 Jahren mit

Permanent sacral nerve modulation for fecal incontinence and associated urinary disturbances

International Journal of Colorectal Disease, 2004

Sacral nerve modulation (SNM) using an implantable pulse generator is gaining increasing acceptance in the treatment of several functional disturbances of the urinary and intestinal tract. This new therapeutic approach offers new possibilities in the treatment of fecal incontinence (FI) by means of its possible effects on anorectal physiology. Patients and methods: Fourteen patients with FI, six of whom had associated urinary disturbances, underwent permanent SNM after successful peripheral nerve evaluation tests. All had a clinical evaluation including FI grading systems (American Medical systems, AMS; Continence Grading System, CGS) and quality of life questionnaires (Fecal Incontinence Quality of Life, FIQL), and anorectal physiology tests performed before and during electrostimulation. Two patients had a lead displacement which was repositioned. Median follow-up was 14 months (range 6-48 months). Results: AMS scores decreased significantly from 101 to 67 after 24 months CGS scores from 15 to 2 after 2 months. The median number of episodes of major incontinence per 2 weeks decreased from 14 to 1 after 24 months. FIQL scores improved significantly in the nine patients tested from an overall score of 1.59 to 3.3, with improvement in all areas of the FIQL. Four of the six patients with associated urinary disturbances had a significant improvement in their symptoms. Anal resting and squeezing tone did not change significantly, nor did rectal volumetry, compliance, rectoanal inhibitory reflex, or length of the anal highpressure zone, while 24-h rectal manometry showed inhibition of the spontaneous rectal motility complexes after meal and on awakening in the only two patients undergoing this investigation. Conclusion: Although the mechanism of action of SMN is still unclear and requires further investigations, clinical results are very encouraging, confirming the role of this new and safe procedure in the treatment of FI and associated urinary disturbances.

Is sacral neuromodulation here to stay? Clinical outcomes of a new treatment for fecal incontinence

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2015

Sacral neuromodulation (SNM) was approved by the FDA for the treatment of fecal incontinence (FI) in 2011, and previous industry-sponsored trials have shown excellent clinical outcomes. The purpose of this study is to examine clinical outcomes of patients treated during our initial experience with SNM. A prospective database of patients treated with SNM for FI by one of three colorectal surgeons at two separate institutions was maintained starting in 2011. Patients showing ≥50% improvement of weekly incontinent episodes during test stimulation were offered permanent implantation of the SNM device. Disease severity was tracked using the Wexner score. A total of 145 patients received a full system implantation (of 152 who received test stimulation). The median preoperative Wexner score of 14 decreased to 3, 3 months after implantation and persisted to 12 months. At 12 months, 95.2% of patients achieved >50% improvement in Wexner Score and 67.6% achieved >75% improvement. The mos...

Efficacy of sacral neuromodulation for symptomatic treatment of refractory urinary urge incontinence

Urology, 2006

Objectives. To determine the efficacy and complications of sacral neuromodulation as therapy for refractory urinary urge incontinence. Methods. Forty-one patients (mean age 54.3 Ϯ 15.8 years) with urge incontinence refractory to conservative therapy (ie, pharmacologic, behavioral, biofeedback therapy) were retrospectively evaluated. The patients included those who received permanent one-staged or two-staged InterStim implants. Surgical implantation of the InterStim was performed in patients who experienced a greater than 50% reduction in urge incontinence symptoms, as documented by voiding diaries during a 3 to 7-day test stimulation period. Results. Ninety percent of patients had 50% or greater improvement in presenting symptoms and qualityof-life parameters after InterStim implantation, with a median follow-up of 12 months (interquartile range 12 to 26.5) for single-stage and 4.5 months (interquartile range 1.5 to 12) for staged implants (P ϭ 0.0003 Wilcoxon rank-sum test). Patients with urge incontinence had a significant reduction in mean leaking episodes (from 8.8 to 2.3 per day, P ϭ 0.0001), with a significant decrease in the mean number of pads used (from 4.7 to 0.82 per day, P Ͻ0.0001). No patient experienced operative complications, and postoperative complications were encountered in 29% of patients. Conclusions. Our results have demonstrated that sacral neuromodulation is a safe and effective approach for the treatment of urinary urge incontinence that is refractory to other more conservative forms of treatment.

Sacral neuromodulation in an older, urge-incontinent population. Discussion

American Journal of Obstetrics and Gynecology, 2002

Durham, NC OBJECTIVE: The success of sacral neuromodulation in the treatment of urge incontinence has been reported in young populations. Herein we report the success in an older, urge-incontinent population. STUDY DESIGN: A cohort of 25 patients older than 55 years who had failed conventional therapy for the treatment of urge incontinence underwent percutaneous S3 sacral nerve test stimulation. Patients were considered candidates for permanent implantation if they were cured or had a greater than 50% improvement in incontinent episodes. Responders were implanted and completed a questionnaire, bladder diary, and disease-specific quality-of-life questionnaire. RESULTS: Twelve of the 25 patients (48%) responded to the test stimulation. The average follow-up after permanent implantation was 7.8 months. All patients obtained a >50% reduction in their incontinent episodes; 2 patients achieved total dryness. CONCLUSION: Our small cohort suggests that older urge-incontinent patients have improvement with sacral neuromodulation but cure rates may be lower than with a younger population.