Sacral Nerve Stimulation in Fecal Incontinence:Are There Factors Associated with Success?
Guillaume Gourcerol,M.D.,Syrine Gallas,M.D.,Francis Michot,Ph.D., Philippe Denis,Ph.D.,Anne-Marie Leroi,Ph.D.
Digestive Tract Research Group EA3234/IFRMP23,Rouen University Hospital,Rouen,France
PURPOSE:Sacral nerve stimulation has been used success-fully in treating fecal incontinence.This study was designed to evaluate the proportion of patients with unsuccessful implantation despite positive test stimulation and to examine and compare factors associated with the success of the transitory and permanent sacral nerve stimulation. METHODS:A total of61patients(55females;median age, 56(range,33–77)years)with refractory fecal incontinence underwent temporary stimulation.A50percent or greater improvement in the number of episodes of fecal inconti-nence or urgency was required to proceed to permanent implantation and was the criteria of success of permanent sacral nerve stimulation at the last follow-up visit in implanted patients.The factors compared between the success and the failure groups during temporary and permanent stimulation were patients_age and gender, diagnosis and characteristics of fecal incontinence,previ-ous surgery,quality of life scores,anorectal manometry, endoanal ultrasound,and electrophysiologic tests per-formed before stimulation.RESULTS:Temporary stimula-tion was successful in35patients(57.4percent).A permanent neurostimulation device was implanted in33 patients.Age was the only factor related to success of the temporary stimulation(P=0.03).After permanent implan-tation,31percent of patients did not attain screening phase results for the number of episodes of fecal incontinence or urgency.A neurologic disorder was more frequently the origin of fecal incontinence in the success group compared with others(P=0.03).The left bulbocavernosus reflex was more frequently delayed in the success group than in the others(P=0.03),and a prolonged or absent bulbocaverno-sus reflex was more frequent in the success group than in the failure group(P=0.03).CONCLUSIONS:Patients with fecal incontinence from neurologic origins could be good candidates for sacral nerve stimulation.[Key words:Fecal incontinence;Sacral nerve stimulation;Electrophysiologic anal test;Perineal neurologic disease;Predictive factors; Treatment]
S acral nerve stimulation,originally developed for urinary voiding dysfunction,has been used for the treatment of patients with fecal incontinence since1995.1Treatment with sacral nerve stimulation has been restricted to patients with at least one episode of fecal incontinence per week,who have failed conservative therapy,and are considering a surgical intervention,as long as they do not present a significant structural defect of the external anal sphincter.2Patients are selected for surgical implan-tation of a permanent neurostimulation device on the basis of clinical improvement during test stimula-tion.3No other predictor of functional outcome with chronic stimulation exists.In a systematic review of six studies,an average of56percent of patients with fecal incontinence seemed to be eligible for perma-nent sacral nerve stimulation after test stimulation (i.e.,they exhibit>50percent improvement in their fecal incontinence episodes during the test stimula-tion,criteria chosen according to the commonly allowed criteria in the literature).2A recent review of studies published for149incontinent patients treated by permanent sacral nerve stimulation
Presented at Digestive Disease Week,Los Angeles,California, May20to25,2006.
Correspondence to:Anne-Marie Leroi,Ph.D.,Physiology Unit, Ho?pital Charles Nicolle,1rue de Germont,Rouen Cedex76031, France,e-mail:email@example.com
Dis Colon Rectum2006;50:3–12
*The American Society of Colon and Rectal Surgeons