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Permanent sacral nerve modulation for fecal incontinence and associated urinary disturbances

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

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 high-pressure 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.

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References

  1. Bosch JL, Groen J (1995) Sacral (S3) segmental nerve stimulation as a treatment of urge-incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neuroprosthesis. J Urol 154:504–507

    CAS  PubMed  Google Scholar 

  2. Matzel KE, Stadelmaier U, Hohenfellner M, Hohenberger W (2001) Chronic sacral spinal nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 44:59–66

    CAS  PubMed  Google Scholar 

  3. Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R (2001) Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology 121:536–541

    Google Scholar 

  4. Ganio E, Ratto C, Masin A, Luc AR, Doglietto GB, Dodi G, Ripetti V, Arullani A, Frascio M, Berti Riboli E, Landolfi V, Del Genio A, Altomare DF, Memeo V, Bertapelle P, Carone R, Spinelli M, Zanollo A, Spreafico L, Giardiello G, de Seta F (2001) Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience. Dis Colon Rectum 44:965–970

    CAS  PubMed  Google Scholar 

  5. Leroi AM, Michot F, Grise P, Denis P (2001) Effect of sacral nerve stimulation in patients with fecal and urinary incontinence. Dis Colon Rectum 44:779–789

    CAS  PubMed  Google Scholar 

  6. Kenefick NJ, Vaizey CJ, Cohen RC, Nicholls RJ, Kamm MA (2002) Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Br J Surg 89:896–901

    Article  CAS  PubMed  Google Scholar 

  7. Martinelli E, Rinaldi M, Mitolo IC, Altomare DF (1997) Computerized analysis of the rectoanal inhibitory reflex in impaired rectal function. Tech Coloproctol 1:64–67

    Google Scholar 

  8. American Medical Systems (1996) Fecal incontinence scoring system. American Medical Systems, Minnesota

  9. Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    PubMed  Google Scholar 

  10. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal incontinence quality of life scale. Quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–17

    PubMed  Google Scholar 

  11. Siegel SW (2002) Sacral nerve stimulation: PNE. In: Jonas U, Grunewald V (eds) New perspectives in sacral nerve stimulation. Duniz, pp 99–106

  12. Ganio E, Masin A, Ratto C, Altomare DF, Ripetti V, Clerico G, Lise M, Doglietto GB, Memeo V, Landolfi V, Del Genio A, Arullani A, Giardiello G, de Seta F (2001) Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders. Dis Colon Rectum 44:1261–1267

    CAS  PubMed  Google Scholar 

  13. Spinelli M, Mamo CA, Arduini A, Gerber M, Giardiello G (2002) Evolution of a minimally-invasive procedure for sacral neuromodulation. In: Jonas U, Grunewald V (eds) New perspectives in sacral nerve stimulation. Duniz, pp 217–222

  14. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127

    CAS  PubMed  Google Scholar 

  15. Malouf AJ, Vaizey CJ, Nicholls RJ, Kamm MA (2000) Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 232:143–148

    Article  CAS  PubMed  Google Scholar 

  16. Vaizey CJ, Kamm MA, Turner IC, Nicholls RJ, Woloszko J (1999) Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 44:407–412

    CAS  PubMed  Google Scholar 

  17. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ (2000) Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 43:298–302

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Mary V. Pragnell, B.A. for correcting the manuscript, N. Ranaldo M.D. for performing the 24-h rectal manometry, and Giuseppe Berlangieri (Medtronic Italia SpA) for assistance with PNE and the implant procedures.

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Authors and Affiliations

  1. Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy

    Donato F. Altomare, Marcella Rinaldi, Maria Petrolino, Pierluca Sallustio, Antonella Veglia, Michele De Fazio, Altomarino Guglielmi & Vincenzo Memeo

  2. IRCCS Fondazione Maugeri, Cassano Murge, Italy

    Vincenzo Monitillo

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  1. Donato F. Altomare
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  2. Marcella Rinaldi
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Correspondence to Donato F. Altomare.

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Altomare, D.F., Rinaldi, M., Petrolino, M. et al. Permanent sacral nerve modulation for fecal incontinence and associated urinary disturbances. Int J Colorectal Dis 19, 203–209 (2004). https://doi.org/10.1007/s00384-003-0523-y

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