Critical appraisal of international guidelines for the management of fecal incontinence in adults: is it possible to define what to do in different clinical scenarios?

Fecal incontinence (FI) is a complex often multifactorial functional disorder which is associated with a significant impact on patients' quality of life. There is a broad spectrum of symptoms, and degrees of severity and diverse patient backgrounds. Several treatment algorithms from different professional societies and experts are available in the literature. However, no consensus has been reached on several aspects of FI management. We performed a critical review of the most recently published guidelines on FI, emphasising the lack of consensus, highlighting specific topics mentioned in each of the guidelines that are not covered in the others and defining the treatment proposed in different clinical scenarios.

Sacral neuromodulation in patients with congenital faecal incontinence. Special issues and review of the literature.

BACKGROUND: The aim of the present study was to evaluate the effectiveness of sacral neuromodulation (SNM) as a treatment for congenital faecal incontinence (FI). METHODS: A retrospective study was conducted on patients with congenital FI who had SNM surgery at our institution between October 2005 and June 2013. An initial percutaneous nerve evaluation was performed, and patients with an improvement of more than 50% in their symptoms had permanently implants for SNM treatment. RESULTS: There were 4 patients who received a permanent implant. Mean duration of follow-up was 67.5 months (range 45-135 months). At last follow-up, 2 patients maintained significant improvement with SNM, 1 was explanted after 4 years of treatment due to infection but remained asymptomatic and SNM failed in the remaining patient who went on to graciloplasty. CONCLUSIONS: SNM may be of value for treating FI in patients with anorectal malformations.

Clinical and cost effectiveness of sacral nerve stimulation for faecal incontinence.

BACKGROUND: Sacral nerve stimulation (SNS) has better results and safety than other surgical procedures for faecal incontinence. This prospective study assessed the clinical effectiveness and costs of SNS at a single centre. METHODS: Patients who had experienced one or more episodes of faecal incontinence were studied for up to 5 years by continence diary, anorectal manometry and quality of life questionnaires. Direct medical costs were calculated and the cost-effectiveness of the treatment was analysed. RESULTS: Fifty-seven percutaneous nerve evaluations were performed in 47 patients between June 1999 and February 2006; 29 patients underwent permanent implantation. After a median follow-up of 34.7 (range 2.3-81.2) months, 25 of the 29 patients had a significant reduction in incontinence episodes; 14 patients were in complete remission. At 3-year follow-up, the mean reduction in incontinence episodes was 89 per cent. No change was observed in anal manometric values. Patients reported a significant improvement in quality of life. The introduction of SNS has an incremental cost-effectiveness ratio, below the accepted Spanish threshold. CONCLUSION: The introduction of SNS to the management of faecal incontinence within the Spanish setting is both effective and efficient.