Ö. Uludağ

Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations.

Objective  Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively.

Sacral neuromodulation in patients with fecal incontinence: a single-center study.

PURPOSE:Fecal incontinence is a psychologically devastating and socially incapacitating condition. Conventional treatment is likely to improve continence in many patients; however, there remains a group with persisting symptoms who are not amenable for a simple surgical repair. We evaluated the effect of sacral neuromodulation in patients with structurally intact sphincters after failure of conventional treatment.METHODS:Patients aged 18 to 75 years were evaluated. Incontinence was defined as involuntary loss of stool at least once per week, which was objectified by completion of a three-week bowel-habits diary during ambulatory electrode stimulation at the S3 or S4 foramen. Patients were qualified for permanent stimulation when showing a reduction of at least 50 percent in incontinence episodes or days.RESULTS:Seventy-five patients (66 females; mean age, 52 (range, 26–75) years) were treated. Three patients had partial spinal cord injury, two patients a previous low-anterior resection, and nine patients had a previous sphincter repair. Evaluation after trial screening showed that 62 patients (83 percent) had improved continence. Median incontinence episodes per week decreased from 7.5 to 0.67 (P < 0.01), median incontinence days per week from 4 to 0.5 (P < 0.01). The symptomatic response stayed unchanged after implantation of a permanent electrode and pacemaker in 50 patients. After a median follow-up of 12 months, this effect could be sustained in 48 patients. Anal manometry during stimulation showed no increase of sphincter pressures.CONCLUSIONS:Sacral neuromodulation is a feasible treatment option for fecal incontinence in patients with structurally intact sphincters.

Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence

Objective  Sacral nerve modulation (SNM) for the treatment of faecal incontinence was originally performed in patients with an intact anal sphincter or after repair of a sphincter defect. There is evidence that SNM can be performed in patients with faecal incontinence and an anal sphincter defect.

Long-term follow-up of dynamic graciloplasty for fecal incontinence

AbstractPURPOSE: Graciloplasty has been used as a treatment for end-stage fecal incontinence since 1946. Electric stimulation with an implantable pulse generator has existed for 15 years. The gracilis muscle is wrapped around the anal canal and stimulated by intramuscular electrodes connected with an implantable pulse generator. Initial reports have been promising, but long-term results have not been presented to date. METHODS: Data of 200 consecutive patients with a follow-up of at least two years were analyzed in a prospective manner from 1986 until 1999. RESULTS: The overall success rate was 72 percent. In patients with fecal incontinence caused by trauma, the rate was 82 percent. Once continent, patients remained continent after a median follow-up of 261 (standard deviation, 132) weeks. Median survival of the implantable pulse generator until battery expiration was 405 weeks. Disturbed evacuation remained a problem in 16 percent of all patients. Complications were frequent but treatable. CONCLUSION: Dynamic graciloplasty is a good, cost-effective treatment for fecal incontinence with results lasting for a median of more than five years.

Sacral neuromodulation: long term outcome and quality of life in patients with faecal incontinence

Aim  Since 1994 sacral neuromodulation (SNM) has increasingly been used for the treatment of faecal incontinence, but no long‐term data in a large group of patients have so far been published. We report long‐term outcome and quality of life in the first 50 patients treated by permanent SNM for faecal incontinence.

Sacral nerve modulation and other treatments in patients with faecal incontinence after unsuccessful pelvic floor rehabilitation: a prospective study

Objectives Sacral nerve modulation (SNM) is a minimally invasive technique for the treatment of faecal incontinence. This study investigates the results of SNM after negative outcome of a standardized pelvic floor rehabilitation (PFR) programme for the treatment of faecal incontinence.

Sacral neuromodulation; does it affect colonic transit time in patients with faecal incontinence?

Objective  Sacral neuromodulation (SNM) has been a successful treatment in urinary voiding disorders for years. A concomitant effect on bowel function was observed leading to the treatment of faecal incontinence with SNM. In this study we describe the effect of SNM on bowel frequency and (segmental) colonic transit time.

Erratum to: Sacral Neuromodulation: Does It Affect the Rectoanal Angle in Patients with Fecal Incontinence?

Erratum to: World J SurgDOI 10.1007/s00268-010-0474-8A revised Conclusions section is as follows:Although the neural supply of the pelvic floor muscu-lature is different from that of the external anal sphincter,this study did not show a statistically significant change inrectoanal angle during SNM. However, a clear tendencywas observed toward a decreased or sharpened rectoanalangle during rest, squeeze, and Valsalva’s maneuver and anincreased or blunted rectoanal angle during defecation. Asmall population size may account for these findings.Further research is necessary for a better understanding ofthe mechanism of action of SNM.