Dis Colon Rectum. 2023 Sep 21. doi: 10.1097/DCR.0000000000002937. Online ahead of print.

Sarah Martin ^1 2, Alexander D O'Connor ^1 2, Deepak Selvakumar ^1 2, Wal Baraza ^1 3, Gemma Faulkner ¹, Domini Mullins ¹, Edward S Kiff ¹, Karen Telford ^1 2, Abhiram Sharma ^1 2

Author information

¹Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom.

²Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom.

³Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Abstract

Background: Sacral neuromodulation is an effective treatment for fecal incontinence.

Objective: This study aimed to assess the long-term outcomes of sacral neuromodulation and establish the outcomes of patients with inactive devices.

Design: This is an observational study of patients treated for more than 5 years. A positive outcome was defined as a >50% reduction in fecal incontinence episodes or improvement in a symptom severity score. Data were reviewed from a prospectively managed database.

Settings: This study was conducted at a single tertiary referral center.

Patients: Data from 74 patients (72 female) were available at long-term follow up.

Main outcome measures: Bowel diary, St. Mark's incontinence score, and Manchester Health Questionnaire data were prospectively recorded at baseline, after peripheral nerve evaluation, and at last follow-up.

Results: Patients were analyzed in cohorts based on time since sacral neuromodulation implantation: Group 1: 5-10 years (n = 20), Group 2: >10 years (n = 35), and Group 3: inactive SNM devices (n = 19). Median St. Mark's incontinence score and Manchester Health Questionnaire improved from baseline to last follow-up in Group 1 (p ≤ 0.05) and Group 2 (p ≤ 0.05), but in Group 3 results returned to baseline levels at last follow-up. Similarly, weekly fecal incontinence episodes improved in both active device groups at last follow-up. However, in Group 3 incontinence episodes were no different from baseline (p = 0.722). Despite active devices, fecal urgency episodes increased at last follow-up after more than 10 years since peripheral nerve evaluation (p ≤ 0.05). Complete continence was reported by 44% of patients, and at least a 50% improvement in 77% with active devices.

Limitations: This study is retrospective with some gaps in the available data at last follow-up.

Conclusions: Sacral neuromodulation is an effective treatment for fecal incontinence in the long term, but all outcomes are adversely affected by device inactivity. Therefore, ongoing stimulation is required for continued benefit.