Updates Surg. 2023 Aug;75(5):1187-1195. doi: 10.1007/s13304-023-01570-z. Epub 2023 Jul 13.

Luigi Brusciano ^# 1, Antonio Brillantino ^# 2, Gianluca Pellino ^3 4, Franco Marinello ⁴, Coen Im Baeten ⁵, Alex Digesu ⁶, Gabriele Naldini ⁷, Claudio Gambardella ³, Francesco Saverio Lucido ³, Alessandro Sturiale ⁷, Giorgia Gualtieri ³, Stefan Riss ⁸, Ludovico Docimo ³

Author information

¹Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. luigi.brusciano@unicampania.it.

²III Department of Surgery, "A. Cardarelli" Hospital, Naples, Italy.

³Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.

⁴Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.

⁵Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.

⁶Department of Urogynaecology, Imperial College NHS Healthcare, London, UK.

⁷Proctology and Perineal Surgical Unit - Proctology and Pelvic Floor Multidisciplinary Clinical Center, Universitary Hospital of Pisa, Pisa, Italy.

⁸Department of Surgery, Medical University Vienna, Vienna, Austria.

^#Contributed equally.

Abstract

Sacral nerve modulation has become an established treatment for fecal and urinary incontinence, and sexual disorders. The objective of this study was to evaluate the long-term outcome of sacral neuromodulation in patients with fecal or combined fecal and urinary incontinence (double incontinence), assessing its safety, efficacy, and impact on quality of life and sexual function. This was a multicentric, retrospective, cohort study including patients with fecal or double incontinence who received sacral neuromodulation at seven European centers between 2007 and 2017 and completed a 5-year follow-up. The main outcome measures included improvements of incontinence symptoms and quality of life compared with baseline, evaluated using validated tools and questionnaires at 1-, 6-, 12-, 36- and 60-month follow-up. 108 (102 women, mean age 62.4 ± 13.4 years) patients were recruited, of whom 88 (81.4%) underwent definitive implantation of the pacemaker. Patients' baseline median Cleveland Clinic Incontinence Score was 15 (10-18); it decreased to 2 (1-4) and 1 (1-2) at the 12- and 36-month follow-up (p < 0.0001), remaining stable at the 5-year follow-up. Fecal incontinence quality of life score improved significantly. All patients with sexual dysfunction (n = 48) at baseline reported symptom resolution at the 5-year follow-up. The study was limited by the retrospective design and the relatively small patient sample. Sacral nerve modulation is an effective treatment for fecal and double incontinence, achieving satisfactory long-term success rates, with resolution of concomitant sexual dysfunction.