Sacral Nerve Stimulation in the Treatment of Fecal Incontinence – Initial Experience in the Czech Republic and Assessment of Functional Outcomes

Česká verze

Authors: P. Šlauf; F. Antoš; P. Dytrych ; J. Marvan; O. Ryska; P. Bartoška
Authors place of work: Chirurgická klinika 1. LF UK a IPVZ, FN Na Bulovce, Praha, přednosta: doc. MUDr. J. Fanta, DrSc.
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 12, s. 674-681.
Category: Monotematický speciál - Původní práce

Podporováno grantem IGA MZ ČR – NS 10461-3/2009.

Summary

Introduction:
During the last decade, sacral nerve stimulation (SNS) has become a new perspective and effective method in the treatment of fecal incontinence. In the Czech Republic, SNSs have been used since 2010.

Methods:
From May 2010 to August 2011, sacral nerve stimulation was performed in 15 patients in FN Na Bulovce Surgical Clinic in Prague. All of the subjects were female patients and their mean age was 59 (46–68 years of age). The first phase of the treatment included the following procedures: percutaneous sacral nerve (S2-S4) examination, electrode implantation and subchronic stimulation. Permanent neurostimulator implantation was indicated in 14 out of the 15 subjects and over 50% of them experienced reduction in incontinence episodes. The following neurostimulators were used: Medtronic InterStim 3023 or InterStim II 3058. Stimulation parameters included 15 Hz frequency, pulse width of 210 μs and the stimulation range was between 1–3 V. The patients’ follow up period was 1–15 months after the procedure.

Outcomes:
After the first phase of SNS, the morbidy rate was 7%. The morbidity rate after the permanent neurostimulator implantation was 0 %. Permanent neurostimulators were implanted in 14 out of the total of 15 subjects, i.e. the success rate was 93 %. Based on the incontinence recording sheet (diary) data collected from all the 14 subjects, the mean number of incontinence epizodes was 24 epizodes / week (± 13.0) before the stimulation and 4 epizodes/ week (± 3.8) after the stimulation procedure. Cleveland Clinic Incontinence Score was assessed in the first 8 subjects and its mean value was 20 (± 0.7) before the procedure, vs. 7 (± 1.2) after the stimulation procedure. The both values were significantly lower after the stimulation procedure (p < 0.05). No significant differences between the manometric values before the procedure and after the stimulation procedure were detected. SF-36 showed improvement in the quality of life, in particular in the parameters assessing social and mental functions. Nevertheless, there were no significant differences in any of the studied parameters.

Conclusion:
The initial experience with SNS in the Czech Republic showed over 50% improvement in continence rates in 93% of the subjects with introduction of stimulation electrodes and subchronic stimulation and over 50% improvement in 100% of the subjects, who underwent permanent neurostimulator implantations, and full continence was achieved in 33% of the subjects.

Key words:
sacral nerve stimulation– fecal incontinence – quality of life – functional outcomes

Zdroje

1. Matzel, K., Stadelmeier, U., Hohenfellner, M., Gall, F. P. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet, 1995, 346, p. 1124–1127.

2. Jarrett, M. E., Mowatt, G., Glazener, C. M., Fraser, C., Nicholls, R. J., Grant, A. M., Kamm, M. A. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br. J. Surg., 2004, Dec; 91 (12): 1559–1569.

3. Matzel, K. E., Kamm, M. A., Stösser, M., Baeten, C. G., Christiansen, J., Madoff, R., Mellgren, A., Nicholls, R. J., Rius, J., Rosen, H. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet, 2004 Apr, 17; 363 (9417): 1270–1276.

4. Matzel, K., Lux, P., Heuer, M., Besendorfer, M., Zhang, W. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis., 2009, vol. 11, issue 6, p. 636–641.

5. Hollingshead, J. R. F., Dudding, T. C., Vaizey, C. J. Sacral nerve stimulation for faecal incontinence: results from a single centre over a 10-year period. Colorectal Dis., 2011, 13, 9, p. 1030–1034.

6. Leroi, A. M., Damon, H., Faucheron, J. L., Lehur, P. A., Siproudhis, L., Slim, K., Barbieux, J. P., Barth, X., Borie, F., Bresler, L., Desfourneaux, V., Goudet, P., Huten, N., Lebreton, G., Mathieu, P., Meurette, G., Mathonnet, M., Mion, F., Orasoni, P., Parc, Y., Portier, G., Rullier, E., Sielezneff, I., Zerbib, F., Michot, F. Sacral nerve stimulation in faecal incontinence : position statement based on a collective experience. Colorectal Dis., 2009, 11, p. 572–583.

7. Rosen, H. R., Urbarz, C., Holzer, B., Novi, G., Schiessel, R. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology, 2001 Sep; 121 (3): 536–541.

8. Dinning, P. G., Fuentealba, S. E., Kennedy, M. L., Lubowski, D. Z., Cook, I. J. Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow-transit constipation. Colorectal Dis., 2007 Feb; 9 (2): 123–132.

9. Michelsen, H. B., Christensen, P., Krogh, K., Rosenkilde, M., Buntzen, S., Theil, J., Laurberg, S. Sacral nerve stimulation for faecal incontinence alters colorectal transport. Br. J. Surg., 2008 Jun; 95 (6): 779–784.

10. Matzel, K. Sacral nerve stimulation for faecal incontinence: its role in the treatment algorithm. Colorectal Dis., 2011, 13, Issue Supplement s2, p. 10–14.

11. Baeten, C., Bartolo, D. C. C., Lehur, P. A., Matzel, K., Pescatori, M., Roche, B., Williams, N. S. Consensus conference on faecal incontinence. Tech. Coloproctol., 2007, 11, p. 225–233.

12. Chan, M. K., Tjandra, J. J. Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter. Dis. Colon Rectum, 2008 Jul; 51 (7): 1015–1024; discussion 1024–1025. Epub 2008 May 17.

13. Jarrett, M. E., Matzel, K. E., Stösser, M., Christiansen, J., Rosen, H., Kamm, M. A. Sacral nerve stimulation for faecal incontinence following a rectosigmoid resection for colorectal cancer. Int. J. Colorectal. Dis., 2005 Sep; 20(5): 446–451. Epub 2005 Apr 21.

14. Matzel, K. E., Stadelmaier, U., Bittorf, B., Hohenfellner, M., Hohenberger, W. Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int. J. Colorectal Dis., 2002 Nov; 17 (6): 430–434. Epub 2002 Jul 3.

15. Stelzner, S., Köhler, K., Hellmich, G., Witzigmann, H. Indications and results of sacral nerve stimulation in faecal incontinence. Zentralbl. Chir., 2008 Apr; 133 (2): 135–141.

16. Jarrett, M. E., Matzel, K. E., Christiansen, J., Baeten, C. G., Rosen, H., Bittorf, B., Stösser, M., Madoff, R., Kamm, M. A. Sacral nerve stimulation for faecal incontinence in patients with previous partial spinal injury including disc prolapse. Br. J. Surg., 2005 Jun; 92 (6): 734–729.

17. Jarrett, M. E., Matzel, K. E., Stösser, M., Baeten, C. G., Kamm, M. A. Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis. Colon Rectum, 2005 Jun; 48 (6): 1243–1248.

18. Boyle, D., Prosser, K., Allison, M., Williams, N., Chan, Ch. Percutaneous tibial nerve stimulation for the treatment of urge faecal incontinence. Dis. Colon Rectum, 2010, 53, 4, p. 432–437.

19. Tan, E., Ngo, N. T., Darzi, A., Shenouda, M., Tekkis, P. P. Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int. J. Colorectal Dis., 2011 Mar; 26 (3): 275–294. Epub 2011 Jan 29.

20. Bock, S., Folie, P., Wolff, K., Marti, L., Engeler, D. S., Hetzer, F. H. First experiences with pudendal nerve stimulation in fecal incontinence: a technical report. Tech. Coloproctol., 2010 Mar; 14 (1): 41–44.