Sacrale neuromodulatie effectief bij fecale incontinentie en intacte kringspieren; een prospectieve studie

To evaluate the therapeutic effect of sacral neuromodulation on faecal incontinence in patients with structurally intact sphincters.

Design

Prospective.

Method

In the period April 1st, 2000 to November 30st, 2001, patients with faecal incontinence and structurally intact sphincters were included, with or without previous surgery, in whom medicinal treatment and biofeedback therapy gave no improvement. Incontinence was defined as involuntary loss of stool at least once a week, which was objectified by completion of a 3-week bowel habit diary. Patients underwent 3 weeks of trial stimulation during which they also kept a diary. The trial stimulation was considered successful if the diary showed a ≥ 50 improvement in continence.

Results

38 patients (31 women) with an average age of 54 years (range: 26-73) underwent trial stimulation. Trail stimulation was carried out using a permanent electrode in 6 patients and using peripheral neural evaluation in the remaining 32 patients. Two patients did not respond to peripheral neural evaluation. Upon assessment after the trial stimulation period, continence was found to have improved by ≥ 50 in 31 (82) patients. The number of incontinence episodes decreased by an average of 86 (range: 50-100). In 27 patients an implantable pulse generator was implanted for continuous stimulation. During the average follow-up of 6 months the effect remained satisfactory. Anal manometry during stimulation showed no increase of sphincter pressures.

Conclusion

Sacral neuromodulation was of therapeutic value in most of the patients treated for faecal incontinence without sphincter damage.