Sacral nerve stimulation as a therapy for fecal incontinence

Abstract

Sacral nerve stimulation (SNS) has developed into the standard procedure in the management of fecal incontinence in the past 20 years. The clinical benefit is reproducible and the patients achieve permanent satisfaction. The method has received high acceptance and continues to spread. This article highlights SNS use in practice in Germany in terms of the recommendations in the literature and guidelines from the manufacturer. We began with a written survey of all German centers active in the therapy for fecal incontinence (152), with 143 being contacted at least twice (143/152; 94,1 %), including 82 items regarding indication, inclusion criteria, contraindication, combined indication, indication for permanent implantation, preoperative diagnostic procedures, nonoperative therapy, operative technique and follow-up of the SNS system and continence. A complete survey was sent back by 70 colorectal surgeons (48.9 %). In terms of classical indications or contraindications for SNS, clear results of 60–97 % were found. Nonuniform replies were found in the secondary indications for SNS, such as anal pain, bloating or irritable bowel syndrome. Interestingly, 37 % of the colorectal surgeons would test patients with a complete spinal injury, although SNS requires residual function of the distal spinal nerves. Nonuniform replies were collected in terms of rare conditions such as anal atresia, cauda equina syndrome and spina bifida. The need of repeated MRI investigations (MRI of the head was not included) was considered to be a contraindication by 55 % of the respondents only, despite the fact that body MRI is contraindicated by the manufacturer. Rather uniform were all items of diagnostic procedures and timing of the operations (70–80 % consensus). Additional uniformity was found in terms of the operative strategy and the steps of follow-up. This German national survey found a strong consensus in the use of sacral nerve stimulation for the management of fecal incontinence.