Percutaneous peripheral neuromodulation in the treatment of fecal incontinence.

ABSTRACT

BACKGROUND/AIMS: To assess the results of peripheral neuromodulation for the treatment of fecal incontinence (FI) resulting from uninhibited rectal contraction (URC) or uninhibited anal sphincter relaxation (UASR). METHODS: The work comprised 32 patients (age 38.2 +/- 6.7 years; 22 women) with FI in whom conventional therapy had failed before enrollment in the study. Twenty-six had URC and 6 UASR. Peripheral neurostimulation was effected by posterior tibial nerve stimulation using a Stoller Afferent Nerve Stimulator (UroSurge, Coralville, lowa, USA). The needle was introduced into the skin cephalad to the medial malleolus. Stimulation (parameters 0.5-10 mA, 200 micros, 20 Hz) was performed every other day for 4 weeks. Functional assessment was done by a questionnaire (incontinence score 0-20) and physiologic studies. RESULTS: Group 1 17 patients (13 URC, 4 UASR) had FI improvement, recording a mean score of 1.7 of 20. Group 2 10 patients (8 URC, 2 UASR) had fair improvement (score 8.6). Group 3 5 patients had poor results (score 14.8). Rectometric recording showed improvement in groups 1 and 2. Recurrence of symptoms occurred in 8 patients; 6 improved after retreatment. CONCLUSIONS: A percutaneous access to the S(3) spinal region was achieved through the posterior tibial nerve. Improvement of FI was achieved in 78.2%. The technique is simple, easy, without complications and cost-effective. It can be done as an outpatient procedure or by the patient at home. The results need to be reproduced on a large number of patients.