Document Detail


Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations.
MedLine Citation:
PMID:  17509049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively. METHOD: Patients treated between March 2000 and May 2005 were included. Faecal incontinence was defined as at least one episode of involuntary faecal loss per week confirmed by a 3-week bowel habit diary. Patients were eligible for implantation of a permanent SNM when showing at least a 50% reduction in incontinence episodes or days during ambulatory test stimulation. Preoperative workup consisted of an X-defaecography, pudendal nerve terminal motor latency measurement, endo-anal ultrasound and anal manometry. The follow-up visits for the permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. The bowel habit diary and anal manometry were repeated postoperatively during the follow-up visits. RESULTS: A total of 134 patients were included and received a subchronic test stimulation. One hundred patients (74.6%) had a positive test stimulation and received a definitive SNM implantation. The permanent implantation group consisted of 89 women and 11 men. The mean age was 55 years (range 26-75). The mean follow-up was 25.5 months (range 2.5-63.2). The mean number of incontinence episodes decreased significantly during the test stimulation (baseline, 31.3; test, 4.4; P < 0.0001) and at follow-up (36 months postoperatively, 4.8; P < 0.0001). There was no significant change in the mean anal resting pressure. The squeeze pressures were significantly higher at 6 months (109.8 mmHg; P = 0.03), 12 months (114.1 mmHg; P = 0.02) and 24 months postoperatively (113.5 mmHg; P = 0.007). The first sensation, urge and maximum tolerable volume did not change significantly. Twenty-one patients were considered late failures and received further treatment. CONCLUSION: Sacral neuromodulation is an effective treatment for FI. The medium-term results were satisfying.
Authors:
J Melenhorst; S M Koch; O Uludag; W G van Gemert; C G Baeten
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2007-05-17
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  9     ISSN:  1462-8910     ISO Abbreviation:  Colorectal Dis     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-14     Completed Date:  2008-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  725-30     Citation Subset:  IM    
Affiliation:
Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Electric Stimulation*
Fecal Incontinence / therapy*
Female
Humans
Male
Middle Aged
Prospective Studies
Sacrum / innervation*
Treatment Outcome*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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