Document Detail


Medium-term outcome of sacral nerve modulation for constipation.
MedLine Citation:
PMID:  22156864     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Bastiaan Govaert; Yasuko Maeda; Job Alberga; Steen Buntzen; Søren Laurberg; Cornelius G Baeten
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  26-31     Citation Subset:  IM    
Affiliation:
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.
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