Neuromodulation For Fecal Incontinence Research Articles

Update on neuromodulation for fecal incontinence

Update on neuromodulation for fecal incontinence

Sacral neuromodulation for faecal incontinence – 10 years experience and long-term outcomes of a specialized centre

Sacral neuromodulation/sacral nerve stimulation (SNM/SNS) has become the most successful method for treatment of faecal incontinence (FI) in the last 10 years. The high efficiency of SNM is based on the electrical stimulation of the external anal sphincter and moreover the mechanism of action of SNS can be explained by the modulation of somatovisceral reflexes and perceptions of afferent information. Therefore the mechanism of action is more complex in contrast to other methods of treatment. In the Czech Republic, the SNM was implemented for the first time in 2010 with the financial support of the IGA grant of the Ministry of Health of the Czech Republic. Since 2018, two specialized centres for the treatment of FI using the SNM method have been established in the Czech Republic. In the years 20102020, 35 patients were indicated for SNM. The ratio of women to men was 34:1. The mean age at implantation was 62 years (range 4675). Most patients were in the 6th and 7th decade. Two diagnostic procedures were performed in all patients, percutaneous evaluation of the S2S4 sacral nerves, implantation of the Medtronic 3889 28cm stimulation tined lead electrode and its connection to an external stimulator and subsequent subchronic stimulation for 24 weeks. The criteria for permanent neurostimulator implantation were a minimum 50% reduction in the number of FI episodes per week or a 50% reduction in incontinence score. Patients were then implanted with a Medtronic InterStim II 3058 permanent neurostimulator. A permanent neurostimulator was implanted in 33 of 35 patients (94%). No patient died. The complication rate was 11.4%. In 2 patients it was an infectious complication. In one patient malposition of the stimulator occurred after falling down and in one patient we observed lead breakage with subsequent malfunction of the stimulator after falling down. All complications were successfully resolved by reoperation. The longterm effect of SNM was evaluated in the group of the first 15 implanted patients from 20102011. Of these, 9 patients were available, in whom a new neurostimulator was reimplanted due to loss of battery power in 20182020. The mean length of follow-up was 112 months (99124). The mean number of FI episodes per week was 1.9 (013) after neurostimulator implantation compared to 13.6 (325) before implantation. The Cleveland Clinic Incontinence Score (CCIS) was 8.3 (316) after neurostimulator implantation compared to CCIS 18.8 (1520) before implantation. Both FI episode counts and CCIS scores were significantly lower (p.

Electrophysiological Responses in the Human S3 Nerve During Sacral Neuromodulation for Fecal Incontinence.

Intra-operative electrode placement for sacral neuromodulation (SNM) relies on visual observation of motor contractions alone, lacking complete information on neural activation from stimulation. This study aimed to determine whether electrophysiological responses can be recorded directly from the S3 sacral nerve during therapeutic SNM in patients with fecal incontinence, and to characterize such responses in order to better understand the mechanism of action (MOA) and whether stimulation is subject to changes in posture. Eleven patients undergoing SNM were prospectively recruited. A bespoke stimulating and recording system was connected (both intraoperatively and postoperatively) to externalized SNM leads, and electrophysiological responses to monopolar current sweeps on each electrode were recorded and analyzed. The nature and thresholds of muscle contractions (intraoperatively) and patient-reported stimulation perception were recorded. We identified both neural responses (evoked compound action potentials) as well as myoelectric responses (far-field potentials from muscle activation). We identified large myelinated fibers (conduction velocity: 36–60 m/s) in 5/11 patients, correlating with patient-reported stimulation perception, and smaller myelinated fibers (conduction velocity <15 m/s) in 4/11 patients (not associated with any sensation). Myoelectric responses (observed in 7/11 patients) were attributed to pelvic floor and/or anal sphincter contraction. Responses varied with changes in posture. We present the first direct electrophysiological responses recorded from the S3 nerve during ongoing SNM in humans, showing both neural and myoelectric responses. These recordings highlight heterogeneity of neural and myoelectric responses (relevant to understanding MOA of SNM) and confirm that electrode lead position can change with posture.

Sacral neuromodulation for fecal incontinence

Sacral neuromodulation for fecal incontinence

Sacral neuromodulation for fecal incontinence and constipation in adult patients with anorectal malformation--a feasibility study in patients with or without sacral dysgenesis.

The aim of this study was to evaluate both the feasibility and effectiveness of sacral neuromodulation for fecal incontinence and constipation in adult patients who had undergone surgical repair of anorectal malformations (ARM). Patients with ARM with or without sacral dysgenesis who presented with fecal incontinence, constipation, or combined symptoms were treated with sacral nerve stimulation (SNS). Success of SNS was assessed by scores preoperatively and after a 3-week test period: Cleveland Clinic Incontinence Score (CCI), Surgical Working Group for Coloproctology (CACP) continence score, German version of the Fecal Incontinence Quality of Life Scale, and Cleveland Clinic Constipation Score (CCCS). The follow-up results of the patients who received a definitive pacemaker were used to evaluate the long-term effect of SNS in patients with ARM. Four patients with fecal incontinence and one patient with constipation (two males, three females; median age 24 years [13; 31]) were treated with SNS between May 2012 and May 2013. Four patients had a normal sacrum; one patient had a sacral dysgenesis. Preoperatively and after the test phase, median CACP continence scores were 8 [1; 10] and 11.5 [3; 16], median CCI 14 [12; 19] and 13 [11; 17], and median Fecal Incontinence Quality of Life Scale improved in all categories. For constipation, CCCSs were 16 and 7. Sacral neuromodulation is a feasible treatment modality for adult patients with ARM with a normally developed sacrum. Patients with sacrum dysgenesis are not suited for SNS because a definitive quadripolar electrode could not be anchored in the absence of a sacral bone.

便失禁に対する仙骨神経刺激療法 前向き多施設共同研究

【はじめに】便失禁はQOLに大きな影響を及ぼす排便障害の一つであるが，これまで有効な治療法が確立されていないのが現状である．仙骨神経刺激療法は便失禁に対する有効性が認められ，欧州では1994年から，米国でも2011年に承認され使用されている．本邦でも本治療法の導入が望まれ，このたび承認申請にむけた前向き多施設共同研究を行ったのでその結果を報告する．【方法】便失禁の頻度が週2回を超える患者を仙骨神経刺激療法の適応とし，各施設の治験審査委員会の承認を得た上で，インフォームドコンセントのもとに治験を行った．最初に仙骨神経刺激用のリード埋め込みを行い，体外式刺激装置による2週間の試験刺激で50％以上の症状改善を認めた症例に，体内埋め込み型刺激装置（InterStim II，米国Medtronic社）を留置した．便失禁の症状は患者自身による排便日誌をもとに評価した．肛門内圧検査は術前および術後1ヵ月，3ヵ月，6ヵ月の時点で施行した．術前と比較して便失禁回数/週が50％以上減少した場合に治療有効と判定した．【結果】2011年1月から11月の間に治験に参加した22人の患者にリード埋め込み術を施行した．便失禁の原因は不明（特発性）10例，直腸術後8例，分娩外傷2例，その他2例であった．試験刺激による症状改善が50％未満であった直腸癌術後の1例はリードを抜去，症状改善が50％以上であった21例（男性9例，女性12例，平均年齢66.6歳）に刺激装置の埋め込みを行った．術後6ヵ月のフォローアップの時点で85.7％の症例が治療有効と判定された．平均便失禁回数/週は術前が14.9回，術後6ヵ月が3.1回と有意に減少した（p=0.0135）．肛門内圧検査では術前の肛門管最大静止圧の平均値が28.4mmHg，術後6ヵ月の平均値が39.1mmHgと有意に上昇した（p=0.0026）．リード埋め込みおよび刺激装置埋め込みによる重篤な合併症は認められなかった．【結語】便失禁に対する仙骨神経刺激療法は安全で有効な治療法である．

Neuromodulation for fecal incontinence: An effective surgical intervention

Fecal incontinence is a disabling symptom with medical and social implications, including fear, embarrassment, isolation and even depression. Most patients live in seclusion and have to plan their life around the symptom, with secondary impairment of their quality of life. Conservative management and biofeedback therapy are reported to benefit a good percentage of those affected. However, surgery must be considered in the non-responder population. Recently, sacral nerve electrostimulation, lately named neuromodulation, has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management, by some unknown mechanism. Neuromodulation is a minimally invasive procedure with a low rate of adverse events and apparently favorable cost-efficacy profile. This review is intended to expand knowledge about this effective intervention among the non-surgically skilled community who deals with this disabled group of patients.

Neuromodulation for fecal incontinence: An effective surgical intervention

Neuromodulation for fecal incontinence: An effective surgical intervention

Neuromodulation for fecal incontinence: Outcome in 32 patients with definitive implant. the Italian sacral neurostimulation group (GINS) experience

Neuromodulation for fecal incontinence: Outcome in 32 patients with definitive implant. the Italian sacral neurostimulation group (GINS) experience