Patey Prize 02

Background: Faecal incontinence is common and associated with a high level of physical and social disability. If conventional treatment fails the remaining options are limited. Sacral nerve stimulation, involving chronic neuromodulation of the sacral nerves, is a novel treatment for this condition. We report our 5-year experience. Methods: Seventeen patients (16 women, median age 59 [37–71]) were implanted with initial temporary, and then permanent stimulators. All had severe incontinence, resistant to maximal conventional treatment, including behavioural therapy. The median preoperative duration of symptoms was 6 years (2–15). Aetiology included obstetric injury (n = 7), scleroderma (4), idiopathic (3), repaired rectal prolapse (2) and fistula surgery (1). Clinical evaluation, endoanal ultrasound, bowel diary, quality of life (SF36) and anorectal physiology were completed before and after treatment. Results: At median follow-up of 26 months (3–62) continence improved significantly in all patients. The median weekly incontinent episodes decreased from 12 (2–30) to 0 (0–7), P < 0.001. Twelve of 17 were fully continent. Urgency improved in all; (mean [standard deviation] ability to defer <1 min [0.5]versus 8 [5], P < 0.01). Maximal anal resting pressure increased during temporary stimulation (35 cm H2O [17]versus 49 [21], P < 0.05) and maximal squeeze pressure with permanent stimulation (44 [40]versus 69 [49], P < 0.01). Rectal threshold sensation to distension improved (47 mL air [19]versus 35 [15], P < 0.05). Other physiological variables did not change significantly. Quality of life improved in all, P < 0.05. There were no major complications. Conclusions: Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when other treatments have failed.