Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience.

PURPOSE: Sacral nerve modulation appears to offer a valid treatment option for\r\nsome patients with fecal incontinence and functional defects of the internal\r\nanal sphincter or of the striated muscle. METHODS: Sixteen patients with fecal\r\nincontinence (4 males; mean age, 51.4 (range, 27-79) years) with intact or\r\nsurgically repaired (n = 1) anal sphincter underwent permanent sacral nerve\r\nstimulation implant. Cause was traumatic in two patients, and associated\r\ndisorders included scleroderma (2 patients) and spastic paraparesis (1 patient);\r\neight (50 percent) of the patients also had urinary incontinence, and two (12.5\r\npercent) had nonobstructive urinary retention. All patients were selected on the\r\nbasis of positive findings from at least one peripheral nerve evaluation. The\r\nstimulating electrode was positioned in the S2 (1 patient), S3 (14 patients), or\r\nS4 (1 patient) sacral foramen. RESULTS: Mean follow-up was 15.5 (range, 3-45)\r\nmonths. Mean preimplant Williams score decreased from 4.1 +/- 0.9 (range, 2-5)\r\nto 1.25 +/- 0.5 (range, 1-2) (P = 0.01, Wilcoxon test), and the number of\r\nincontinence accidents for liquid or solid stool in 14 days decreased from 11.5\r\n+/- 4.8 (range, 2-20) before implant to 0.6 +/- 0.9 (range, 0-2) at the last\r\nfollow-up. Important manometric data were an increase in mean maximal pressure\r\nat rest of 37.7 +/- 14.9 mmHg (implantable pulse generator 49.1 +/- 18.7, P =\r\n0.04) and in mean maximal pressure during squeeze (prestimulation 67.3 +/- 21.1\r\nmmHg, implantable pulse generator 82.6 +/- 21.0, P = 0.09). CONCLUSIONS:\r\nNeuromodulation can be considered an option for fecal incontinence. However, an\r\naccurate clinical and instrumental evaluation and careful patient selection are\r\nrequired to optimize outcome.