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 some patients with fecal incontinence and functional defects of the int ernal anal sphincter or of the striated muscle. METHODS: Sixteen patients w ith fecal incontinence (4 males; mean age, 51.4 (range, 27-79) years) with intact or surgically repaired (n = 1) anal sphincter underwent permanent sa cral nerve stimulation implant. Cause was traumatic in two patients, and as sociated disorders included scleroderma (2 patients) and spastic paraparesi s (1 patient); eight (50 percent) of the patients also had urinary incontin ence, and two (12.5 percent) had nonobstructive urinary retention. All pati ents were selected on the basis of positive findings from at least one peri pheral nerve evaluation. The stimulating electrode was positioned in the S2 (1 patient), S3 (14 patients), or S4 (1 patient) sacral foramen. RESULTS: Mean follow-up was 15.5 (range, 3-45) months. Mean preimplant Williams scor e decreased from 4.1 +/- 0.9 (range, 2-5) to 1.25 +/- 0.5 (range, 1-2) (P = 0.01, Wilcoxon test), and the number of incontinence accidents for liquid or solid stool in 14 days decreased from 11.5 +/- 4.8 (range, 2-20) before implant to 0.6 +/- 0.9 (range, 0-2) at the last follow-up. Important manome tric data were an increase in mean maximal pressure at rest of 37.7 +/- 14. 9 mmHg (implantable pulse generator 49.1 +/- 18.7, P = 0.04) and in mean ma ximal pressure during squeeze (prestimulation 67.3 +/- 21.1 mmHg, implantab le pulse generator 82.6 +/- 21.0, P = 0.09). CONCLUSIONS: Neuromodulation c an be considered an option for fecal incontinence. However, an accurate cli nical and instrumental evaluation and careful patient selection are require d to optimize outcome.