Medium-term results with Sacral Nerve Stimulation for management of faecal incontinence, a single centre experience

Abstract

OBJECTIVE Sacral Nerve Stimulation (SNS) is an effective but expensive intervention for management of Faecal Incontinence (FI) offered primarily in tertiary centres. It is estimated that 30%-50% of patients fail to respond to temporary SNS. Aim of this study was to evaluate the value of anorectal investigations in patient selection and also to report the mid-term patient results and SNS related morbidity in a secondary referral centre. METHOD 38 patients (36 female) with FI were offered temporary SNS between January 2008 - May 2012. 32/38 (84%) proceeded to permanent SNS implantation. Patient baseline demographics, anorectal manometry/electrophysiology and endoanal sonography results at baseline were analysed retrospectively. Patient quality of life and symptomatology post-implantation were evaluated by means of a postal quality of life questionnaire.SNS related morbidity was also assessed. RESULTS Median patient age was 62 years (29-74) and baseline Wexner score was 14 (6-19). Patient outcome after temporary stimulation was associated with age and the sensory threshold of urge to defecate. (p<0.05) The rest of baseline demographics and anorectal investigations did not affect the outcome. At a median timepoint of 16 months (3-42) patient quality of life and severity of symptoms had improved significantly compared to baseline. (p<0.05) SNS device explantation and site infection rates were zero. CONCLUSION Benefit from SNS is maintained up to 2 years on follow-up. Anorectal investigations have little value in predicting the outcome of temporary SNS phase.