Sacral Nerve Neuromodulation in the Treatment of Faecal Incontinence

Česká verzia

Authors: P. Vlček ¹; I. Čapov ¹; L. Veverková ¹ ; J. Korbička ¹; J. Cagaš ¹; P. Vlčková ²; Jiří Dolina ² ; D. Bartušek ³; H. Streitová ⁴
Authors place of work: I. chirurgická klinika LF MU a FN u sv. Anny v Brně ¹; Interní gastroenterologická klinika LF MU a FN Brno ²; Radiologická klinika LF MU a FN Brno ³; I. neurologická klinika LF MU a FN u sv. Anny v Brně ⁴
Published in the journal: Cesk Slov Neurol N 2014; 77/110(3): 349-352
Category: Short Communication

Podporováno grantovým projektem IGA MZ ČR 10249– 3/ 2009.

Summary

Background:
Faecal incontinence causes a high degree of physical, social and psychological impairment. Surgical management is often unsatisfactory, with variable outcome and limited further options. Sacral nerve stimulation uses electrical stimulation applied to the sacral nerves, eliciting a physiological effect on pelvic floor.

Aim:
The aim of our work was to evaluate the effect of sacral nerve neuromodulation in idiopathic faecal incontinence patients.

Methods:
We reviewed the results of sacral nerve neuromodulation according to defined indication criteria. Neuromodulation always followed a rehabilitation, including the use of biofeedback. We analyzed exact measurements of anal sphincters (anorectal manometry).

Results:
Neuromodulation improved faecal incontinence significantly in more than 50% patients. Anorectal manometry values correlate with subjective improvement in symptoms.

Conclusion:
Neuromodulation is a minimally invasive method that effectively corrects faecal incontinence with minimal morbidity.

Key words:
faecal incontinence – neuromodulation – anal sphincters

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Matzel KE, Schmidt RA, Tanagho EA. Neuroanatomy of the striated muscular anal continence mechanism: implications for the use of neurostimulation. Dis Colon Rectum 1990; 33(8): 666– 673.

2. Schmidt RA, Senn E, Tanagho EA. Functional evaluation of sacral nerve root integrity. Report of a technique. Urology 1990; 35(5): 388– 392.

3. Schmidt RA. Applications of neurostimulation in urology. Neurourol Urodyn 1988; 7(6): 585– 592.

4. Thon WF, Baskin LS, Jonas U, Tanagho EA, Schmidt RA. Surgical principles of sacral foramen electrode implantation. World J Urol 1991; 9(3): 138– 141.

5. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP.Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995; 346(8983): 1124– 1127.

6. Kenefick NJ, Vaizey CJ, Cohen RC, Nicholls RJ, Kamm MA. Medium‑term results of permanent sacral nerve stimulation for faecal incontinence. Br J Surg 2002; 89(7): 896– 901.

7. Matzel KE, Stadelmaier U, Hohenfellner M, Hohenberger W. Chronic sacral spinal nerve stimulation for fecal incontinence: long‑term results with foramen and cuff electrodes. Dis Colon Rectum 2001; 44(1): 59– 66.

8. Špác J, Kianička B. Diabetes mellitus a hypertenze. Postgraduální medicína 2010; 12(8): 945– 949.

9. Špác J, Souček M, Kianička B. Diuretika u hypertenze. Med pro praxi 2010; 7(3): 105– 110.

10. Špác J, Kianička B. Nové postupy v antikoagulační léčbě u seniorů s fibrilací síní. Kardiol Rev 2012; 14(1): 22– 26.

11. Řiháček I, Fráňa P, Souček M, Plachý M, Kianička B.Diurnální variabilita krevního tlaku u pacientů s hypertenzí a revmatoidní artritidou. Vnitř Lék 2009; 55(2): 111– 116.

12. Kianička B, Bílková I. Neobvyklý ERCP nález cizího tělesa v hepatocholedochu a jeho úspěšné endoskopické odstranění. Cesk Slov Gastroent 1996; 50(2): 48– 51.

13. Kianička B, Bednařík L, Simonová H. Přínos akutní terapeutické ERCP na gastroenterologickém pracovišti: zhodnocení významu endoskopických pohotovostních služeb. Cesk Slov Gastroent 1997; 51(5): 156– 160.

14. Dítě P, Papík Z, Novotný I, Kunovská M, Kianička B,Zavoral M et al. Prospektivní multicentrická studie endoskopické terapie akutní biliární pankreatitidy versus akutní cholangoitidy. Cesk Slov Gastroent Hepatol 2005; 59(4): 635– 638.

15. Dítě P, Papík Z, Kunovská M, Novotný I, Kianička B, Piskač P et al. Urgentní endoskopická papilosfinkterotomie u osob starších 70 let. Vnitř Lék 2005; 51(5): 529– 532.

16. Kianička B, Dítě P, Suškevič I. Endoskopická diagnostika a léčba biliárních komplikací po laparoskopické cholecystektomii. Vnitř Lék 2007; 53(11): 1182– 1189.

17. Kianička B, Dítě P, Piskač P. Endoskopická diagnostika a léčba pankreatobiliárních onemocnění u pacientů po resekci žaludku podle Billrotha II. Vnitř Lék 2009; 55(11): 1043– 1050.

18. Ganio E, Luc AR, Lerico G, Trompetto M. Sacral nerve stimulation for treatment of fecal incontinence: a novel approach for intractable fecal incontinence. Dis Colon Rectum 2001; 44(5): 619– 629.

19. Vaizey CJ, Kamm MA, Turner IC, Nicholls RJ, Woloszko J. Effects of short‑term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 1999; 44(3): 407– 412.

20. Malouf AJ, Vaizey CJ, Nicholls RJ, Kamm MA. Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 2000; 232(1): 143– 148.

21. Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology 2001; 121(3): 536– 541.

22. Leroi AM, Michot F, Grise P, Denis P. Effect of sacral nerve stimulation in patients with fecal and urinary incontinence. Dis Colon Rectum 2001; 44(6): 779– 789.

23. Matzel KE, Kamm MA, Stösser M, Baeten CG, Christiansen J, Madoff R et al. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 2004; 363(9417): 1270– 1276.

24. Kenefick NJ, Emmanuel A, Nicholls RJ, Kamm MA. Effect of sacral nerve stimulation on autonomic nerve function. Br J Surg 2003; 90(10): 1256– 1260.

25. Kenefick NJ, Vaizey CJ, Nicholls RJ, Cohen R, Kamm MA. Sacral nerve stimulation for faecal incontinence due to systemic sclerosis. Gut 2002; 51(6): 881– 883.

26. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ. Double‑blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2000; 43(3): 298– 302.

27. Vaníček J, Krupa P. Vyšetření zobrazením magnetickou rezonancí v urologických indikacích. Urol List 2006; 4(2): 44– 49.

28. Pette D, Vrbova G. Adaptation of mammalian skeletal muscle fibers to chronic electrical stimulation. Rev Physiol Biochem Pharmacol 1992; 120: 115– 202.

29. Salmons S, Henricksson J. The adaptive response of skeletal muscle to increased use. Muscle Nerve 1981; 4(2): 94– 105.