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PWE-388 Is posterior tibial nerve stimulation an effective treatment for faecal incontinence?
  1. J Nicholson1,
  2. J Pearson2,
  3. C Molyneux1,
  4. K Telford1,
  5. A Sharma1,
  6. E Kiff1
  1. 1Department of General Surgery
  2. 2Neurogastroenterology Unit, UHSM, Manchester, UK

Abstract

Introduction Posterior tibial nerve stimulation (PTNS) is a new neuromodulation treatment for faecal incontinence (FI). Our aim of this study was to establish if PTNS is effective, and for which subgroups of FI and whether it influences manometry variables.

Method Prospective observational cohort study in a tertiary pelvic floor unit. Patients received PTNS for 30 mins once a week for 12 weeks. High resolution anal manometry (HRAM), 2-week bowel diary, FI severity score (Vaizey), FI specific QOL questionnaire (MHQ) were recorded before and 2-weeks after treatment. Clinical data and subjective patient reported outcomes (success/fail) were recorded.

Results 23 patients, 19 (83%) women, median age 62 (31–78). 12 (52%) mixed incontinence, 7 (30%) urge incontinence, 4 (18%) passive incontinence. We found a reduction in the mean number of urgency episodes (19 v 11, p = 0.002), urge FI episodes (6 v 2, p = 0.038) and passive FI episodes (12 v 8, p = 0.154), with an improvement in Vaizey (16.7 v 14.4, p = 0.003) and MHQ (481.9 v 413.1 p = 0.039) scores.

All HRAM variables (mmHg) increased; MRP (40 v 46, p = 0.088), MSP (72 v 92, p = 0.009) and ISP (32 v 45, p = 0.031). Increased rectal sensation (mls); onset (42 v 33, p = 0.064), call (80 v 54, p = 0.000) and urge (112 v 82, p = 0.001).

Subjective success occurred in 74% (17), 4 of 6 that failed had passive incontinence. Objective success (defined as >50% or >70% improvement in 2 or more of the following; overall FI episodes, urgency episodes, urge FI episodes, passive FI episodes, Vaizey and MHQ scores) was seen in 52% (12) and 39% (9) respectively. 3 of the 4 men did not improve subjectively or objectively.

Conclusion PTNS subjectively helped 17 of 23 patients, reflected in improved questionnaires and fewer incontinence episodes. They had increased rectal awareness and stronger squeeze pressures which may have given them more warning and the ability to defer defecation. This study suggests that PTNS appears to help women with urge incontinence.

Disclosure of interest None Declared.

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