Ke. Matzel et al., Chronic sacral spinal nerve stimulation for fecal incontinence: Long-term results with foramen and cuff electrodes, DIS COL REC, 44(1), 2001, pp. 59-66
PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for
patients with severe fecal incontinence owing to functional deficits of the
external anal sphincter. It aims to use the morphologically intact anatomy
to recruit residual function. This study evaluates the long-term results o
f the first patients treated with this novel approach applying two techniqu
es of sacral spinal nerve stimulator implantation. METHODS: Six patients un
derwent either of two techniques for electrode placement: one "closed" (ele
ctrodes placed through the sacral foramen) and one "open" (cuff electrodes
placed after sacral laminectomy). Follow-up evaluation of their continence
status ranged from 5 to 66 months. RESULTS: Incontinence improved in all pa
tients. The percentage of incontinent bowel movements decreased during chro
nic stimulation from a mean of 40.2 percent to 2.8 percent, and the Wexner
score decreased from a mean of 17 to 2. The function of the striated anal s
phincter improved during chronic stimulation: maximum squeeze pressure incr
eased from a mean of 48.5 mmHg to 92.7 mmHg, and median squeeze pressure in
creased from a mean of 37.3 mmHg to 72.5 mmHg. No complications were encoun
tered perioperatively or postoperatively. Two devices had to be removed bec
ause of intractable pain, in one patient at the site of the electrode after
five months and in the other at the site of the impulse generator after 45
months. CONCLUSION: Long-term sacral spinal nerve stimulation persistently
improves continence and increases striated anal sphincter function in pati
ents with fecal incontinence owing to functional deficits, but in whom the
striated anal sphincter is morphologically intact. Two different operative
approaches can be applied effectively.