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Sacral Nerve Neuromodulation Is Effective Treatment for Fecal Incontinence in the Presence of a Sphincter Defect, Pudendal Neuropathy, or Previous Sphincter Repair

Brouwer, Richard M.B.B.S.; Duthie, Graeme M.D.

Diseases of the Colon & Rectum: March 2010 - Volume 53 - Issue 3 - pp 273-278
doi: 10.1007/DCR.0b013e3181ceeb22
Original Contribution

PURPOSE: To assess the effectiveness of sacral nerve neurostimulation in the setting of sphincter defects, previous sphincter repair, or pudendal neuropathy.

METHODS: A total of 55 patients underwent insertion of a sacral nerve neurostimulator for fecal incontinence. There were 52 female and 3 male patients, with a mean age of 51 (range, 25–65) years and a median follow-up of 37 (range, 15–41) months.

RESULTS: There was a significant improvement in the median Cleveland Clinic continence score for all of the patients, from a median of 15 (13–18) before insertion of the neurostimulator, to a median of between 4 and 7 during the follow-up period of up to 48 months. (P < .001–.008). Patients with a sphincter defect on endoanal ultrasound, a pudendal neuropathy, or a previous sphincter repair did not show any significant differences in continence scores during the follow-up period (P = .46, .25, and .81, respectively). The Fecal Incontinence Quality of Life score also showed a significant improvement on all 4 scales, Lifestyle (median 2.00 baseline to 3.00–3.70 P = .001–.008), Coping/Behavior (median 1.56 baseline to 2.89–3.22 P = .001–.007), Depression/Self-Perception (median 2.29 baseline to 2.93–3.71 P = .001–.005), and Embarrassment (median 1.50 baseline to 2.17–3.00 P = .001–.013) after insertion at all time intervals up to 36 months. The Fecal Incontinence Quality of Life score was higher than the baseline at 48 months but only statistically significant for Lifestyle (median 3.10, P = .04) and Coping/Behavior (median 2.63, P = .03) scores. There were 6 device-related complications.

CONCLUSIONS: Sacral nerve neuromodulation results in a significant improvement in fecal incontinence and Fecal Incontinence Quality of Life scores after medium-term follow-up, even when there is a sphincter defect or pudendal neuropathy.

Academic Surgical Unit, University of Hull, Hull, United Kingdom

Financial Disclosure: Graeme Duthie is a UK trainer of neuromodulation for Medtronic Inc.

Presented at the meeting of The American Society of Colon and Rectal Surgeons and Tripartite, Boston, MA, June 7 to 11, 2008.

Correspondence: Graeme Duthie, M.D., Academic Surgical Unit, University of Hull, Cottingham HU16 5JQ, UK. E-mail: g.s.duthie@hull.ac.uk

© The ASCRS 2010