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Sacral nerve modulation for fecal incontinence; five-year experience
*Anne C Granfield, Steven Schechter, *Leslie Roth, Adam Klipfel
Brown University, Providence, RI
Objective: To evaluate the effectiveness of sacral nerve modulation for relief of fecal incontinence.
Design: Retrospective review
Setting: Specialty ambulatory referral center for colorectal diseases.
Patients: Patients seen in the office for fecal incontinence who elected to have sacral nerve modulation between 2011-2015
Interventions: Sacral nerve modulation placement. Neuromodulators were placed after initial nerve testing showed positive results. Patients were seen for at least 3-6 month follow-up after the study began.
Main Outcome Measure: Cleveland Clinic Fecal Incontinence score. A secondary measure was patient satisfaction.
Results: There were a total of 46 sacral nerve insertions between 2011-2015. There were 5/46 stimulators removed for nonfunction and/or need for MRI. There were 31/46 patients who continued to follow-up in the office for sacral nerve modulation. The CCFI scores were analyzed using a paired t test to ascertain whether there was a significant difference in incontinence scores after sacral nerve modulation. Preoperative average score was 14.7 and postoperative was 5.2. The mean average decrease in CCFI scores was 9.93 (+/- 5.58 with p<0.000115) after the sacral nerve modulation. Also 28/31 (90%) had a decrease in CCFI score; 21/31 (68%) had a decrease in >50%. There was no correlation in patients with pudendal neuropathy towards a larger decrease in CCFI score (p<0.12). There was also no correlation in decreased CCFI score in patients who had a sphincter defect (p<0.23). The infection rate was 1/31 (3.2%)
Conclusions: Sacral nerve modulation is a safe and minimally invasive treatment option for patients with fecal incontinence with acceptable morbidity. This study shows a statistically significant decrease in fecal incontinence scores after sacral nerve modulation.
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