Outcome of Sacral Nerve Stimulation for Fecal Incontinence in Patients Refractory to Percutaneous Tibial Nerve Stimulation

BACKGROUND:Percutaneous tibial nerve stimulation and sacral nerve stimulation are both second-line treatments for fecal incontinence, but the comparative efficacy of the 2 therapies is unknown. In our institution, patients with refractory fecal incontinence are generally treated with percutaneous tibial nerve stimulation before being considered for sacral nerve stimulation. OBJECTIVE:The aim of this study was to assess the outcome associated with this treatment algorithm in order to guide future management strategies. DESIGN:All patients with fecal incontinence treated over a 3-year period with tibial nerve stimulation before receiving sacral nerve stimulation were identified from a prospectively recorded database. Demographics and pretreatment anorectal physiological data were available for all patients. SETTINGS:This study was conducted at an academic colorectal unit in a tertiary center. PATIENTS:Twenty patients (17 female:3 male, median age 55 (33–79) years) were identified to be refractory to percutaneous tibial nerve stimulation. MAIN OUTCOME MEASURES:Clinical outcome data were collected prospectively before and after treatment, including 1) Cleveland Clinic Florida-Fecal Incontinence scores and 2) number of incontinence episodes per week. RESULTS:The mean (±SD) pretreatment incontinence score (11.7 ± 3.5) did not differ from the mean incontinence score after 12 sessions of tibial nerve stimulation (10.9 ± 3.6, p = 0.42). All patients were subsequently counseled for sacral nerve stimulation, and 68.4% of them reported a significant therapeutic benefit with an improved incontinence score (7.7 ± 4.1, p = 0.014). LIMITATIONS:This was a nonrandomized study with a relatively small number of patients CONCLUSION:Sacral nerve stimulation appears to be an effective treatment for patients who do not gain an adequate therapeutic benefit from percutaneous tibial nerve stimulation and, thus, should be routinely considered for this patient cohort.