Neuromodulation. 2024Aug17:S10947159(24)006494.doi:10.1016/j.neurom.2024.06.504. Online ahead of print.

Erica Eggers ¹, Tess Crouss ², Jasjit Beausang ², Devon Smith ², Sean Spector ², Benjamin Saracco ³, Amanda Adams ³, Taylor Dickinson ², Lioudmila Lipetskaia ²

Author information

¹Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ, USA. Electronic address: ericalynnee@gmail.com.

²Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ, USA.

³Cooper Medical School of Rowan University, Camden, NJ, USA.

Abstract

Introduction: Sacral nerve stimulation (SNS) has now been used as a treatment for fecal incontinence (FI) for >20 years. The aim of this systematic review was to determine the long-term efficacy of SNS on the treatment of FI.

Materials and methods: A comprehensive search of the MEDLINE, Embase, and Cochrane Central data bases was performed to find publications, excluding case reports, reporting outcomes of SNS treatment for FI in adults with ≥36 months of follow-up. Bias was assessed using the Risk of Bias in Non-randomized Studies-of Interventions tool. Data were summarized per reported FI-related outcomes for symptom severity and quality of life.

Results: In total, 3326 publications were identified, and 36 studies containing 3770 subjects were included. All studies had a serious risk of bias. Success was variably defined by each publication and ranged from 59.4% to 87.5% for per-protocol analyses and 20.9% to 87.5% for intention-to-treat analyses. All studies reporting bowel diary data, St Mark's scores, and Cleveland Clinic Incontinence Scores indicated significant improvement with SNS treatment in the long term. Studies that evaluated quality-of-life outcomes also all showed improvements in quality of life as measured by the Fecal Incontinence Quality of Life Scale. The aggregate revision rate was 35.2%, and the explantation rate was 19.7%.

Conclusions: Improvements in objective and subjective outcomes at ≥36 months support using SNS for the long-term treatment of FI. Interpretation of these data is limited by a lack of comparative trials and heterogeneity of the included studies.