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Sacral nerve stimulation at subsensory threshold does not compromise treatment efficacy: results from a randomized,
Jakob Duelund-Jakobsen1, Steen Buntzen, Lilli Lundby
1Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade, Aarhus C, Denmark. Jakob_Jakobsen@hotmail.com
Annals of Surgery
|September 25, 2012
Summary
Lowering sacral nerve stimulation (SNS) amplitude to 50% of the sensory threshold (ST) effectively manages fecal incontinence (FI). This finding suggests that subsensory stimulation is a viable option for FI treatment.
Area of Science:
- Urology
- Gastroenterology
- Neuromodulation
Background:
- Sacral nerve stimulation (SNS) is a common treatment for fecal incontinence (FI).
- Current SNS therapy typically uses stimulation amplitudes at or just above the sensory threshold (ST).
- The efficacy of reduced stimulation amplitudes below the sensory threshold for FI management is not well-documented.
Purpose of the Study:
- To evaluate the effectiveness of sacral nerve stimulation (SNS) at reduced amplitudes (75% and 50% of sensory threshold) compared to stimulation at the sensory threshold for treating fecal incontinence (FI).
Main Methods:
- A randomized, blinded crossover study design was employed.
- Eligible patients with FI and significant symptom reduction (≥75%) on SNS were enrolled.
- Patients underwent 4-week periods of stimulation at ST, 75% ST, and 50% ST, completing bowel habit diaries and validated questionnaires.
Main Results:
- Nineteen patients completed the study, with a mean follow-up of over 50 months.
- Reducing stimulation amplitude to 50% of ST did not significantly alter the number of fecal incontinence episodes (P = 0.078).
- Patient satisfaction remained high and did not decrease with reduced stimulation amplitudes (P = 0.932).
Conclusions:
- Subsensory stimulation, even at 50% of the sensory threshold, is as effective as stimulation at or above the sensory threshold for managing fecal incontinence.
- These findings support the use of lower stimulation amplitudes in sacral nerve stimulation therapy for FI, potentially improving patient comfort and device longevity.
