Sacral nerve stimulation for fecal incontinence. What has been achieved (current status).

Abstract

The indications for sacral nerve stimulation (SNS) for fecal incontinence expanded during the last decade. This report aims to analyse the clinical outcome of the current pragmatic use of sacral nerve stimulation in the treatment of fecal incontinence caused by various pathophysiological conditions. Secondly it intends to explore the most recent use of SNS in patients presenting with sphincteric lesions. The literature was searched using Medline and Cochrane databases. The search was limited to publications in English. For the analysis, studies with less than 25 patients were excluded. For the presentation of SNS in patients with sphincter defects, all papers were included. Thirteen publications were included in the analysis of clinical outcome of SNS. Ten papers were identified reporting about the application of SNS in patients presenting with a morphological sphincter lesion. The most common outcome measures of clinical efficacy were frequency of incontinence and Cleveland Clinic Incontinence Score. All studies demonstrated a highly improved function, in all outcome measures used. The improvement was significant. The results are reproducible. Also in patients with sphincteric gaps ranging form 17 to 180 degree SNS was clinical efficient. The size of the lesion had not impact on the outcome. Sacral spinal nerve stimulation has evolved to become a clinical efficient therapy applicable in a wide spectrum of causes leading to fecal incontinence. It is now considered to be an essential part of the current surgical treatment algorithm for fecal incontinence.