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Medium-Term Outcome of Sacral Nerve Modulation for Constipation

Govaert, Bastiaan M.D.1; Maeda, Yasuko M.R.C.S.2,3; Alberga, Job M.Phil.1; Buntzen, Steen M.D., D.M.Sc.2; Laurberg, Søren M.D., D.M.Sc.2; Baeten, Cornelius G. M.D., Ph.D.1

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e31823898a5
Original Contributions
Abstract

BACKGROUND: Sacral nerve modulation has been reported as a minimally invasive and effective treatment for constipation refractory to conservative treatment.

OBJECTIVE: This study aimed to evaluate the efficacy and sustainability of sacral nerve modulation for constipation in the medium term (up to 6 years) and to investigate potential predictors of treatment success.

DESIGN: We performed a retrospective review of prospectively collected data.

SETTINGS: The study was performed at 2 tertiary-care centers in Europe with expertise in pelvic floor disorders and sacral nerve modulation.

PATIENTS: Patients were eligible if they had had symptoms of constipation persisting for at least 1 year, if conservative treatment (dietary modification, laxatives and biofeedback therapy) had failed, and if predefined excluded conditions were not present.

INTERVENTION: The first phase of the treatment process was percutaneous nerve evaluation. If this was successful, patients underwent sacral nerve modulation therapy with an implanted device (tined-lead and implantable pulse generator).

MAIN OUTCOME MEASURE: Follow-up was performed at 1, 3, 6, and 12 months, and yearly thereafter. Outcome was assessed with the Wexner constipation score.

RESULTS: A total of 117 patients (13 men, 104 women) with a mean age of 45.6 (SD, 13.0) years underwent percutaneous nerve evaluation. Of these, 68 patients (58%) had successful percutaneous nerve evaluation and underwent implantation of a device. The mean Wexner score was 17.0 (SD, 3.8) at baseline and 10.2 (SD 5.3) after percutaneous nerve evaluation (p < .001); the improvement was maintained throughout the follow-up period, although the number of patients continuing with sacral nerve modulation at the latest follow-up (median, 37 months; range, 4–92) was only 61 (52% of all patients who underwent percutaneous nerve evaluation). The sole predictive factor of outcome of percutaneous nerve evaluation was age: younger patients were more likely than older patients to have a successful percutaneous nerve evaluation phase.

LIMITATIONS: The study was limited by a lack of consistent outcome measures.

CONCLUSIONS: Despite improvement in Wexner scores, at the latest follow-up sacral nerve modulation was only being used by slightly more than 50% of the patients who started the first phase of treatment. Further studies are needed to reassess the efficacy and sustainability of sacral nerve modulation.

Author Information

1 Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

2 Surgical Research Unit and Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark

3 Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, United Kingdom

Financial Disclosure: Dr Buntzen has received an honorarium from Medtronic (Minneapolis, MN) as a speaker. Dr Laurberg received an honorarium from Medtronic as a member of the medical advisory board. Dr Baeten is a consultant to Medtronic. Drs Govaert, Maeda, and Alberga reported no conflict of interest.

Correspondence: Bastiaan Govaert, M.D., Maastricht University Medical Center, Department of Surgery, Postal Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: b.govaert@mumc.nl

© The ASCRS 2012