SNS effective long-term for treatment of fecal incontinence
MedWire News: Sacral nerve stimulation (SNS) is an effective long-term treatment for fecal incontinence, research shows.
Limited data from a single center suggests that SNS is efficacious up to 10 years, although some patients experience some deterioration in symptoms over time, report researchers.
"Although all three patients followed for 10 years reported ongoing benefit, others showed some loss of efficacy over time," write Carolynne Vaizey (St Mark's Hospital, Middlesex, UK) and colleague in the journal Colorectal Disease.
The initial treatment for fecal incontinence is dietary modification, constipating medication, and behavioral feedback.
Surgery, however, is the first-line treatment when medical therapy fails to alleviate symptoms. In patients with a structurally intact, but functionally weak, sphincter, SNS has been used as a surgical option since 1995.
Despite the widespread use of the procedure, there are limited long-term data available on the effectiveness of the procedure. Most case reports are limited to short-term follow-up.
In this cohort analysis, Vaizey and colleagues assessed the efficacy of SNS in patients treated at a single center in the UK. Temporary SNS was performed in 118 patients, and of these, 91 were considered eligible for chronic stimulation. In total, 86 permanent implants were performed.
The median time for follow-up was 22 months, although 18 patients were followed-up for more than 5 years, and three patients for more than 10 years.
Of the 70 patients followed-up for 1 year, postprocedural success, defined using bowel habit diaries and incontinence scores, was maintained in 90% of patients.
Among the 18 patients followed for 5 years, 15 (83%) patients reported continued SNS success. Three patients reported complete loss of efficacy.
Of the patients with success at 5 years, 11 patients reported full efficacy, while four patients reported some deterioration of symptoms.
All three patients followed-up for over 10 years reported continuing benefit of SNS. Two patients had no episodes of fecal incontinence over a 2-week diary period, while one patient reported passive incontinence twice weekly.
"The patients who reported partial loss of efficacy did so after a longer period of stimulation," report Vaizey and colleagues.
Patients who had an initial successful permanent stimulation but who then had a complete loss of efficacy did so within the first 2 years, with about half of patients failing therapy in the first year.
Ongoing deterioration of the patient's disease or a loss of response to the stimulation might be the reason for the lack of efficacy.
"In a few patients, loss of efficacy might follow revisional surgery to replace the battery or reset the pulse generator," write the researchers. "In some patients, efficacy can be restored by adjusting of the amplitude, frequency and pulse width of stimulation."
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