Sacral spinal nerve stimulation for faecal incontinence: multicentre study

K.E. Matzel, M.A. Kamm, M. Stosser, C.G.M.I. Baeten, J. Christiansen, R. Madoff, A. Mellgren, R.J. Nicholls, J. Rius, H. Rosen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Sacral spinal nerve stimulation for faecal incontinence: multicentre study.

Matzel KE, Kamm MA, Stosser M, Baeten CG, Christiansen J, Madoff R, Mellgren A, Nicholls RJ, Rius J, Rosen H.

Department of General Surgery, University Hospital Erlangen, Erlangen, Germany. Klaus.Matzel@chir.imed.uni-erlangen.de

BACKGROUND: In patients with faecal incontinence in whom conservative treatment fails, options are limited for those with a functionally deficient but morphologically intact sphincter. We investigated the effect of sacral nerve stimulation on continence and quality of life. METHODS: In this multicentre prospective trial, 37 patients underwent a test stimulation period, followed by implantation of a neurostimulator for chronic stimulation in 34. Effect on continence was assessed by daily bowel-habit diaries over a 3-week period and on quality of life by the disease-specific American Society of Colon and Rectal Surgeons (ASCRS) questionnaire and the standard short form health survey questionnaire (SF-36). Every patient served as his or her own control. FINDINGS: Frequency of incontinent episodes per week fell (mean 16.4 vs 3.1 and 2.0 at 12 and 24 months; p<0.0001) for both urge and passive incontinence during median follow-up of 23.9 months. Mean number of days per week with incontinent episodes also declined (4.5 vs 1.4 and 1.2 at 12 and 24 months, p<0.0001), as did staining (5.6 vs 2.4 at 12 months; p<0.0001) and pad use (5.9 vs 3.7 at 12 months; p<0.0001). Ability to postpone defecation was enhanced (at 12 months, p<0.0001), and ability to completely empty the bowel was slightly raised during follow-up (at 12 months, p=0.4122). Quality of life improved in all four ASCRS scales (p<0.0001) and in seven of eight SF-36 scales, though only social functioning was significantly improved (p=0.0002). INTERPRETATION: Sacral nerve stimulation greatly improves continence and quality of life in selected patients with morphologically intact or repaired sphincter complex offering a treatment for patients in whom treatment options are limited.
Original languageEnglish
Pages (from-to)1270-1276
Number of pages6
JournalLancet
Volume363
Issue number9417
DOIs
Publication statusPublished - 1 Jan 2004

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