[Sacral nerve stimulation in the treatment of fecal incontinence--initial experience in the Czech Republic and assessment of functional outcomes]. / Stimulace sakrálního nervu v lécbe fekální inkontinence--první zkusenosti v Ceské republice a hodnocení funkcních výsledku.

INTRODUCTION: During the last decade, sacral nerve stimulation (SNS) has become a new perspective and effective method in the treatment of fecal incontinence. In the Czech Republic, SNSs have been used since 2010. METHODS: From May 2010 to August 2011, sacral nerve stimulation was performed in 15 patients in FN Na Bulovce Surgical Clinic in Prague. All of the subjects were female patients and their mean age was 59 (46-68 years of age). The first phase of the treatment included the following procedures: percutaneous sacral nerve (S2-S4) examination, electrode implantation and subchronic stimulation. Permanent neurostimulator implantation was indicated in 14 out of the 15 subjects and over 50% of them experienced reduction in incontinence episodes. The following neurostimulators were used: Medtronic InterStim 3023 or InterStim II 3058. Stimulation parameters included 15 Hz frequency, pulse width of 210 micros and the stimulation range was between 1-3 V. The patients' follow up period was 1-15 months after the procedure. OUTCOMES: After the first phase of SNS, the morbidy rate was 7%. The morbidity rate after the permanent neurostimulator implantation was 0 %. Permanent neurostimulators were implanted in 14 out of the total of 15 subjects, i.e. the success rate was 93 %. Based on the incontinence recording sheet (diary) data collected from all the 14 subjects, the mean number of incontinence epizodes was 24 epizodes/week (+/- 13.0) before the stimulation and 4 epizodes/week (+/- 3.8) after the stimulation procedure. Cleveland Clinic Incontinence Score was assessed in the first 8 subjects and its mean value was 20 (+/- 0.7) before the procedure, vs. 7 (+/- 1.2) after the stimulation procedure. The both values were significantly lower after the stimulation procedure (p <0.05). No significant differences between the manometric values before the procedure and after the stimulation procedure were detected. SF-36 showed improvement in the quality of life, in particular in the parameters assessing social and mental functions. Nevertheless, there were no significant differences in any of the studied parameters. CONCLUSION: The initial experience with SNS in the Czech Republic showed over 50% improvement in continence rates in 93% of the subjects with introduction of stimulation electrodes and subchronic stimulation and over 50% improvement in 100% of the subjects, who underwent permanent neurostimulator implantations, and full continence was achieved in 33% of the subjects.

[Reconstruction of anal sphincters following fecal incontinence and assessment of functional results]. / Rekonstrukce análních sveracu pro fekální inkontinenci a hodnocení funkcních výsledku.

The aim of the study was to assess functional results of surgical sphincter reconstructions for anal incontinence. From August 1999 to January 2007, 52 patients (females 50, males 2), 45 y.o.a. on average (24-69), underwent secondary anal sphincters reconstructions for fecal incontinence, resulting from birth injuries, event. in combination with sphincter weakening in pudendal neurophathy, or for post-anorectal surgery incontinence. Duration of the incontinence symptoms prior to the surgery was 2 months to 19 years. The overlap technique in combination with anterior levatorplasty was used in most subjects (n = 31). In 12 subjects, anterior sphincters and levators plication was performed. Four patients underwent overlap reconstructions only and five patients underwent complete sphincter reconstructions. Protective colostomy was performed in six patients. Six patients underwent additional postoperative biofeedback. Endoanal ultrasound was performed in all patients prior to their procedures. Terminal motor latency examination of the pudendal nerve was indicated in all patients with sphincter dysfunction without localized defects. Anal manometry was recorded prior and post-operatively. Incontinence was assessed using the St. Mark's incontinence score (0-13). The patients assessed the reconstruction results based on the Likert scale. The reconstruction was successfull in 46 patients (88.5 %), full continence was recovered in 20 (38.5 %) patients and improvement of incontinence was recorded in 26 (50 %) subjects. In six subjects (11.5 %), the reconstruction failed. The mean incontinence score reduction following the procedure was from 11.8 to 2.4. The short-term sphincter reconstruction results were successful in the majority of the subjects, the long-term results will be assessed in another study.