Document Detail


Sacral nerve stimulation for faecal incontinence due to systemic sclerosis.
MedLine Citation:
PMID:  12427794     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Faecal incontinence occurs in over one third of patients with systemic sclerosis. The aetiology is multifactorial. Conventional treatment is often unsuccessful. Sacral nerve stimulation is a new effective treatment for resistant faecal incontinence. AIMS: To evaluate sacral nerve stimulation in patients with systemic sclerosis. PATIENTS: Five women, median age 61 years (30-71), with scleroderma associated faecal incontinence were evaluated. All had failed maximal conventional treatment. Median number of preoperative weekly episodes of incontinence was 15 (7-25), median duration of incontinence was five years (5-9), and scleroderma 13 years (4-29). METHODS: All patients were screened with temporary stimulation. Those who benefited underwent permanent implantation. At baseline and after stimulation a bowel diary, the SF-36 quality of life assessment, endoanal ultrasound, and anorectal physiology were performed. RESULTS: Four patients were continent at a median follow up of 24 months (6-60). One patient failed temporary stimulation and was not permanently implanted. The weekly episodes of incontinence decreased from 15, 11, 23, and 7 to 0. Urgency resolved (median time to defer <1 minute (0-1) v 12.5 minutes (5-15)). Quality of life, especially social function, improved. Endoanal ultrasound showed an atrophic internal anal sphincter (median width 1.0 mm (0-1.6)). Anorectal physiology showed an increase in median resting pressure (37 pre v 65 cm H(2)O post) and squeeze pressure (89 v 105 cm H(2)O). Stimulation produced enhanced rectal sensitivity to distension. There were no major complications. CONCLUSIONS: Sacral nerve stimulation is a safe and effective treatment for resistant faecal incontinence secondary to scleroderma. The benefit is maintained in the medium term.
Authors:
N J Kenefick; C J Vaizey; R J Nicholls; R Cohen; M A Kamm
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  51     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-11-12     Completed Date:  2002-12-17     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  881-3     Citation Subset:  AIM; IM    
Affiliation:
St Mark's Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anal Canal / physiopathology
Electric Stimulation Therapy / methods*
Electrodes, Implanted
Fecal Incontinence / etiology,  physiopathology,  therapy*
Female
Humans
Lumbosacral Plexus*
Middle Aged
Rectum / physiopathology
Scleroderma, Systemic / complications*,  physiopathology
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