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Neurogastroenterology/motility
Pudendal nerve stimulation for faecal incontinence in patients who have failed sacral nerve stimulation
  1. A George *,
  2. T C Dudding,
  3. R J Nicholls,
  4. C J Vaizey
  1. 1Physiology, St Mark's Hospital, London, UK

Abstract

Introduction Sacral nerve stimulation (SNS), though an accepted treatment for faecal incontinence (FI) is effective only in 60–65% of patients.1 Stimulating the pudendal nerve could activate multiple sacral nerve roots and provide a better efficacy of therapy-though this has been attempted to-date only for urological dysfunction.2

The effect of pudendal nerve stimulation (PNS) in patients with FI was investigated in a prospective observational study.

Methods FI patients who had not responded to conservative treatments and SNS underwent insertion of a permanent PNS stimulation electrode3 followed by a 3-week screening period. A permanent neurostimulator was implanted for a ≥50% reduction in number of incontinence episodes per week as measured by a 3 week prospectively kept bowel diary.

Results Seven female patients (mean age: 56 years) underwent temporary screening. Four of the 7 patients (57%), during the 3-week trial phase, showed a ≥50% reduction in the weekly incontinence episodes (mean (SD) 14 (10.7) pre to 7 (7.2) post)) along with a simultaneous improvement in their ability to defer defecation (minutes (SD) 2 (0.74) pre to 6 (5.8) post). The St Mark's Score improved from (mean;(SD)) 20 (2.3) pre to 12 (1.8) at the 1 month follow-up.

One patient lost efficacy 3 months post permanent implant and voluntarily exited the study. Over a mean follow-up of 8 months (SD 3.6), the improvement in continence was sustained in all the other three patients with no complications reported to date.

Conclusion PNS is a promising new treatment for faecal incontinence in patients who fail to respond to SNS.

  • fecal incontinence
  • Pudendal nerve stimulation
  • sacral nerve stimulation

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Footnotes

  • Competing interests None.

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