| Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation. | |
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MedLine Citation:
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PMID: 16721520 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed. There have been several hypotheses concerning the mode of action of sacral nerve stimulation, but the mechanism is still unclear. This study was designed to evaluate the results of rectal volume tolerability, rectal pressure-volume curves, and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation. METHODS: Twenty-nine patients with incontinence (male/female ratio = 6/23; median age, 58 (range, 29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test. Wexner incontinence score, rectal distention with thresholds for "first sensation," "desire to defecate," and "maximal tolerable volume," rectal pressure-volume curves, anal resting pressure, and maximum squeeze pressure were evaluated at baseline and at six months follow-up. RESULTS: Median Wexner incontinence score decreased from 16 (range, 6-20) to 4 (range, 0-12; P < 0. 0001). Median "first sensation" increased from 43 (range, 16-230) ml to 62 (range, 4-186) ml (P = 0.1), median "desire to defecate" from 70 (range, 30-443) ml to 98 (range, 30-327) ml (P = 0.011), and median "maximal tolerable volume" from 130 (range, 68-667) ml to 166 (range, 74-578) ml (P = 0.031). Rectal pressure-volume curves showed a significant increase in rectal capacity (P < 0.0001). The anal resting pressure increased significantly from 31 (range, 0-109) cm H(2)O to 38 (range, 0-111) cm H(2)O (P = 0.045). No significant increase in maximum squeeze pressure was observed. CONCLUSIONS: For patients with fecal incontinence successfully treated with sacral nerve stimulation, there was a significant increase in rectal volume tolerability and rectal capacity. A significant increase in anal resting pressure, but not in maximum squeeze pressure, was found. We suggest that sacral nerve stimulation causes neuromodulation at spinal level. |
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Authors:
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Hanne B Michelsen; Steen Buntzen; Klaus Krogh; Søren Laurberg |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 49 ISSN: 0012-3706 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2006 Jul |
Date Detail:
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Created Date: 2006-07-13 Completed Date: 2006-10-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
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Languages: eng Pagination: 1039-44 Citation Subset: IM |
Affiliation:
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Surgical Research Unit, Department of Surgery L, Aarhus University Hospital, Aarhus Sygehus, Tage-Hansens Gade, Denmark. hbn@mail.tele.dk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anal Canal / innervation, physiopathology Electric Stimulation Therapy / methods* Fecal Incontinence / physiopathology, therapy* Female Humans Lumbosacral Plexus / physiopathology Male Manometry Middle Aged Pelvic Floor / innervation Rectum / innervation, physiopathology Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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