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Effect of sacral neuromodulation on the rectum
O Uludag1, G L Morren, C H C Dejong
1Department of General Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
The British Journal of Surgery
|July 6, 2005
Summary
Sacral neuromodulation (SNM) significantly lowers rectal sensory thresholds for faecal incontinence patients. This treatment impacts rectal sensitivity, but the precise mechanism requires further investigation.
Area of Science:
- Gastroenterology
- Neuroscience
- Urology
Background:
- Sacral neuromodulation (SNM) is an emerging treatment for faecal incontinence.
- The precise mechanism of action for SNM remains unclear.
- SNM may influence rectal sensitivity, wall tension, and compliance via sacral reflex arc modulation.
Purpose of the Study:
- To investigate the effects of sacral neuromodulation on rectal sensory perception in patients with faecal incontinence.
- To explore the potential mechanisms underlying SNM's efficacy in treating faecal incontinence.
Main Methods:
- Fifteen patients with faecal incontinence underwent barostat measurements before and during SNM.
- An isobaric phasic distension protocol was employed using a rectal bag connected to a barostat system.
- Patients reported rectal filling sensations (first sensation, earliest urge, maximum tolerated volume), and rectal wall tension and compliance were calculated.
Main Results:
- SNM significantly reduced median volume thresholds for all rectal filling sensations (FS, EUD, MTV).
- Pressure thresholds for evoking the maximum tolerated volume (MTV) were significantly reduced during SNM.
- Median rectal wall tension decreased significantly with SNM, while rectal compliance showed no significant change.
Conclusions:
- Sacral neuromodulation demonstrably affects rectal sensory perception in patients with faecal incontinence.
- Further research is necessary to fully elucidate the underlying mechanisms of SNM's therapeutic effects.