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Sacral nerve stimulation for constipation: do we still miss something?

Role of psychological evaluation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to try to understand if psychological evaluation of patients candidate to sacral nerve stimulation (SNS) could be a potential selection criterion to identify those patients who could successfully respond to this treatment.

Materials and methods

From 2005 to 2007, 68 patients with slow transit constipation were identified, and all of them fulfill the selection criteria for the SNS treatment. The MMPI-2 test was purposed to all the patients. Wexner score, bowel movements, and SF36 were recorded in all the patients.

Results

Twenty-three patients (33.8%) refused the psychological evaluation. Forty-five patients completed the test: only 13 patients (19.1%) had a score in the normal range of the scales of the MMPI-2 and were implanted with the temporary test for SNS. After the screening period, 11 patients (84.6%) reported more than 50% improvement of bowel movements per week and no need of laxatives, so they were definitively implanted. The mean follow-up period was 22 months (range 12–36). The mean number of bowel movements per week and Wexner score were significantly improved after 1 year (p < 0.001).

Conclusions

A complete and accurate psychological evaluation could be very important in the selection of the patients with STC that could benefit from SNS.

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References

  1. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG et al (1993) US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography and health impact. Dig Dis Sci 38:1569–1580

    Article  CAS  PubMed  Google Scholar 

  2. Stewart WF, Liberman JN, Sandler RS et al (1999) Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 94:3530–3540

    Article  CAS  PubMed  Google Scholar 

  3. Bassotti G, Bellini M, Pucciani F et al (2004) An extended assessment of bowel habits in a general population. World J Gastroenterol 10:713–716

    PubMed  Google Scholar 

  4. Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics and predictors of health care seeking. Am J Gastroenterol 96:3130–3137

    Article  CAS  PubMed  Google Scholar 

  5. Sonnenberg A, Koch TR (1989) Period and generation effects on mortality from idiopathic inflammatory bowel disease. Dig Dis Sci 34:1720–1729

    Article  CAS  PubMed  Google Scholar 

  6. Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne K (2005) The health-related quality of life and economic burden of constipation. Pharmacoeconomics 23:461–476

    Article  PubMed  Google Scholar 

  7. Talley NJ (2004) Definitions, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord 4(2):S3–S10

    PubMed  Google Scholar 

  8. Chang L, Toner BB, Fukudo S et al (2006) Gender, age, society, culture, and the patient's perspective in the functional gastrointestinal disorders. Gastroenterology 130:1435–1446

    Article  PubMed  Google Scholar 

  9. Chiotakakou-Faliahou E, Kamm MA, Roy AJ, Storrie JB, Turner IC (1998) Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 42:517–521

    Google Scholar 

  10. Kamm MA, Hawley PR, Lennard-Jones JE (1988) Outcome of colectomy for severe idiopathic constipation. Gut 29:969–973

    Article  CAS  PubMed  Google Scholar 

  11. Lubowski DZ, Chen FC, Kennedy ML, King DW (1996) Results of colectomy for severe slow transit constipation. Dis Colon Rectum 39:23–29

    Article  CAS  PubMed  Google Scholar 

  12. Knowles CH, Scott M, Lunniss PJ (1999) Outcome of colectomy for slow transit constipation. Ann Surg 230:627–638

    Article  CAS  PubMed  Google Scholar 

  13. Wong SW, Lubowski DZ (2007) Slow transit constipation: evaluation and treatment. ANZ J Surg 77:320–328

    Article  PubMed  Google Scholar 

  14. Tanagho EA, Schnidt RA (1982) Bladder pacemaker: scientific basis and clinical future. J Urol 20:29–35

    Article  Google Scholar 

  15. Pettit PD, Thompson JR, Chen AH (2002) Sacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction. Curr Opin Obstet Gynecol 14:521–525

    Article  PubMed  Google Scholar 

  16. Whitehead WE (1996) Psychological aspects of functional gastrointestinal disorders. Gastroenterol Clin North Am 25:21–34

    Article  CAS  PubMed  Google Scholar 

  17. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA (1999) Functional bowel disorders and functional abdominal pain. Gut 45(suppl 2):II43–II47

    PubMed  Google Scholar 

  18. Drossman DA (1999) The functional gastrointestinal disorders and the Roma II process. Gut 45(suppl II):II1–II6

    Article  PubMed  Google Scholar 

  19. Tellegen A, Ben-Porath YS, McNulty JL, Arbisi PA, Graham JR, Kaemmer B (2003) The MMPI-2 Restructured Clinical Scales: development, validation, and interpretation. University of Minnesota Press, Minneapolis

    Google Scholar 

  20. Binford A, Liljequist L (2008) Behavioral correlates of selected MMPI-2 clinical, content, and restructured clinical scales. J Pers Assess 90(6):608–614

    Article  PubMed  Google Scholar 

  21. Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B (1989) The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): manual for administration and scoring. University of Minnesota Press, Minneapolis

    Google Scholar 

  22. Spinelli M, Giardiello G, Gerber M, Arduini A, Van Den Hombergh U, Malaguti S (2003) New sacral neuromodulation lead for percutaneous implantation using local anesthesia: description and first experience. J Urol 170:1905–1907

    Article  PubMed  Google Scholar 

  23. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685

    Article  CAS  PubMed  Google Scholar 

  24. Jenkinson C, Coulter A, Wright L (1993) Short Form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ 306:1437–1440

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  26. Matzel KE, Kamm MA, Stosser M, Baeten CGM, Christiansen J, Madoff R, Mellgren A, Nicholls RJ, Rius J, Rosen H (2004) Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 363:1270–1276

    Article  PubMed  Google Scholar 

  27. Jarrett MED, Mowatt G, Glazener CMA, Fraser C, Nicholls RJ, Grant AM, Kamm MA (2004) Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559–1569

    Article  CAS  PubMed  Google Scholar 

  28. 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, Giardiell 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

    Article  CAS  PubMed  Google Scholar 

  29. Malouf AJ, Wiesel PH, Nicholls T, Nicholls RJ, Kamm MA (2002) Short term effects of sacral nerve stimulation for idiopathic slow transit constipation. World J Surg 26:166–170

    Article  PubMed  Google Scholar 

  30. Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA (2002) Permanent sacral nerve stimulation for treatment of idiopathic constipation. Br J Surg 89:882–888

    Article  CAS  PubMed  Google Scholar 

  31. Holzer B, Rosen HR, Novi G, Ausch C, Holbling N, Hofmann M, Schiessel R (2008) Sacral nerve stimulation in patients with severe constipation. Dis Colon Rectum 51:524–529

    Article  CAS  PubMed  Google Scholar 

  32. Dinning PG, Fuentealba SE, Kennedy ML, Lubowski DZ, Cook IJ (2007) Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow transit constipation. Colorectal Dis 9:123–132

    Article  CAS  PubMed  Google Scholar 

  33. Heymen S, Wexner SD, Gulledge AD (1993) MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum 36:593–596

    Article  CAS  PubMed  Google Scholar 

  34. Pescatori M, Spyrou M, Pulvirenti d'Urso A (2006) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis 8:785–789

    Article  CAS  PubMed  Google Scholar 

  35. Valori RM, Kumar D, Wingate DL (1986) Effects of different types of stress and of "prokinetic" drugs on the control of the fasting motor complex in humans. Gastroenterology 90:1890–1900

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pelvic Floor Center, Hospital “Franchini”, Montecchio Emilia, Italy

    Alfonso Carriero, Pasquale Talento & Carlo Andrea Ferrari

  2. General Surgery I, University of Siena, Ospedale Le Scotte, viale Bracci 1, 53100, Siena, Italy

    Jacopo Martellucci

Authors
  1. Alfonso Carriero
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  2. Jacopo Martellucci
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  3. Pasquale Talento
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  4. Carlo Andrea Ferrari
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Corresponding author

Correspondence to Jacopo Martellucci.

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Contribution of Authors

CA: Head of the research group

MJ: Responsible of the study and main writer

TP: Collaborator for the relations with patients

FCA: Collaborator for the data recovering

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Carriero, A., Martellucci, J., Talento, P. et al. Sacral nerve stimulation for constipation: do we still miss something?. Int J Colorectal Dis 25, 1005–1010 (2010). https://doi.org/10.1007/s00384-010-0891-z

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