Introduction Faecal incontinence affects up to 18% of the adult population1 with obstetric trauma being the most common risk factor.2,3 Multiple techniques are used in its management with neuromodulation becoming increasingly popular. SNS is a safe and effective treatment for FI but has associated morbidity4 and costs.5 PTNS is an alternative that evolved from the treatment of urinary incontinence,6 involving stimulation of the tibial nerve. We aimed to assess functional outcome in patients treated with PTNS initially, post treatment and in those that have completed follow up at 1 year.
Methods All patients undergoing neuromopdulation with PTNS in our institution were included. Treatment regimens of 30 min PTNS for 12 weeks were undertaken. Patients were assessed with pre, post treatment and in those that qualify at 1 year with validated questionnaires. The questionnaires included the CCFIS and Rockwood FIQOL score. Data was analysed with SPSS using the Wilcoxon signed rank test with significance at p < 0.05.
Results 40 patients underwent PTNS, 36 female with median age 60 years (range 34–85). 30 were successful with a trial of PTNS, 9 failing and one lost to follow up. Of successful patients a further 4 were lost to follow up at a year. CCFIS scores were significantly improved in the post treatment group (n = 38) with z=-3.75, p < 0.05 r=-0.43 and at 1 year (n = 9) z=-0.26, p < 0.05, r =-0.63. Comparison of the individual components of the FIQOL scores demonstrated significant improvement (p < 0.05) in lifestyle, coping, depression and embarrassment scores post treatment and at 1 year all other than lifestyle continued to show significance.
Conclusion PTNS shows significant benefit in CCFIS scores and FIQOL scores post treatment and at 1 year. Whilst patient numbers at 1 year are small this treatment is in its infancy and further long term studies will be needed to confirm benefit over time.
References 1 Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009:137:512–517
2 Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med. 1992;326:1002–1007
3 Zutshi M, Tracey TH, Bast J, Halverson A, Na J. Ten-year outcomeafter anal sphincter repair for fecal incontinence. Dis Colon Rectum 2009:52:1089–1094
4 Dudding TC, Meng Lee E, Faiz O, Pares D, Vaizey CJ, McGuire A, et al. Economic evaluation of sacral nerve stimulation for faecal incontinence. Br J Surg 2008:95: 1155–1163
5 Sprange K, Clift M, Burke M, Whitehead SR, Hutton J. Evidence Review: Sacral Nerve Stimulation for Faecal Incontinence. Healthcare Innovation and Technology Evaluation Centre (HITEC): Derby, 2009
6 McGuire EJ, Zhang SC, Horwinski ER, Lytton B. Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol 1983:129: 78–79
Disclosure of Interest None Declared.
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