A team from Vienna, Austria, investigated the use of sacral nerve stimulation for the treatment of fecal incontinence (FI).
Since November 1998, 20 patients were treated for severe FI. The cause of FI was mainly neurologic (n = 15), and was idiopathic in 5 patients.
Patients received temporary (subchronic) external stimulation over a period of 10-14 days. In those whose continence status improved, a permanent quadripolar lead and a subcutaneously implanted pulse generator was subsequently implanted.
Acute (needle) testing revealed a positive pelvic floor response in 16 patients who underwent subsequent permanent implantation.
The authors found that the median number of incontinence episodes, following the procedure, decreased from 6 episodes to 2, over a period of 21 days.
The researchers also measured the period of retention of a volume of saline causing an urge until definitive defecation. This increased from 2 minutes preoperatively, to 7.5 minutes postoperatively.
|Improvements following nerve stimulation:|
- Incontinence episodes reduced
- Retention of saline until defecation increased
- Resting and squeeze pressures increased
In addition, results of preoperative and postoperative (3 months) anal manometry showed a statistically significant increase in maximal resting and squeeze pressures.
Harald R. Rosen, of the Danube Hospital, Vienna, concluded on behalf of the group, "Sacral nerve stimulation seems to be a new and promising modality for patients with certain types of fecal incontinence, in whom conventional treatment options have failed to achieve an improvement."