Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: Results in 40 patients

• DOI: 10.1007/bf02234782
• Publication Date: 2005-10-21T01:58:50Z
• Authors: E. Ganio; A. Masin; C. Ratto; D. F. Altomare; V. Ripetti; G. Clerico; M. Lise; G. B. Doglietto; V. Memeo; V. Landolfi; A. Del Genio; A. Arullani; G. Giardiello; F. de Seta
• Keywords: Pudendal nerve; Fecal Incontinence; Defecography; Anorectal manometry; Lumbosacral plexus

PURPOSE: There are several options in the treatment of fecal incontinence; it is often difficult to choose most appropriate, adequate treatment. The consolidated experience gained urologic field suggests that sacral nerve stimulation may be a further option choice aim our study was evaluate preliminary results peripheral evaluation test obtained multicenter collaborative on patients with defecatory and urinary disturbances. METHODS: Forty (9 males; mean age, 50.2; range, 26-79 years) underwent test, 28 (70 percent) for incontinence 12 (30 chronic constipation. Fourteen (35 also had six urge incontinence, two stress retention incontinence. Associated diseases were scleroderma (2 patients), spinal injuries (4 syringomyelia (1 patient). All investigations anorectal manometry, pudendal terminal motor latency testing, anal ultrasound, defecography, if required, urodynamic tests. electrode positioned percutaneously under local anesthesia S2 (4), S3 (34), or S4 (1) foramen unilaterally patient not accounted because no response acute test), based best subjective responses paresthesia pelvic floor. Stimulation parameters average amplitude, 2.8 (range, 1-6) V frequency, 15 25 Hz. RESULTS: duration tests 9.9 7-30) days; lasting fewer than seven days evaluated. four early displacements electrode. In 22 evaluable there an improvement symptoms (88 percent), 11 (44 completely continent liquid solid stools, whereas 7 unchanged. Mean number episodes stool per week 8.1 4-18) prestimulation period 1.7 0-12) during test. (P =0.001; Wilcoxon's signed-rank test). important manometric findings were: increase maximum rest pressure (39.4 ± 7.3 vs. 54.3 8.5 mmHg; P =0.014, test) squeeze (84.7 8.8 99.5 1.1 =0.047), reduction initial threshold (63.6 5.2 42.4 4.7 ml; =0.041) sensation (123.8 0.6 78.3 8.9 =0.05). An found constipation, difficulty emptying rectum, at 2-21) end 2.1 0-6) week, <0.01) unsuccessful visits toilet, which dropped from 29.2 (7-24) 6.7 (0-28) =0.01). constipated amplitude (prestimulation, 63 0 mm Hg; 78 1 =0.009) rectal volume 189 52 139 45 = 0.004). CONCLUSIONS: functional bowel disorders short-term seems useful diagnostic tool assess minor invasive therapy alternative conventional surgical procedure.