Dynamic Article: Percutaneous Nerve Evaluation Versus Staged Sacral Nerve Stimulation for Fecal Incontinence

Area of Science:

• Urology
• Gastroenterology
• Neurology

Background:

• Sacral neuromodulation (SNM) is a standard therapy for fecal incontinence.
• A two-staged approach is commonly used for SNM.
• Office-based percutaneous nerve evaluation (PNE) is a less invasive alternative for SNM evaluation but is underutilized for fecal incontinence.

Purpose of the Study:

• To compare the clinical success of PNE versus the traditional staged approach for SNM in fecal incontinence patients.
• To evaluate the efficacy and safety of PNE as a primary SNM evaluation method.

Main Methods:

• Retrospective review of a prospectively maintained single-institution database.
• Comparison of 86 consecutive patients undergoing SNM for fecal incontinence.
• Patients were divided into two groups: those who underwent PNE (n=45) and those who underwent a staged approach (n=41).
• Primary outcome: proportion of patients with >50% improvement in Wexner score during the testing phase.

Main Results:

• No significant difference in baseline Wexner scores between groups.
• Similar success rates for PNE (82.2%) and staged approach (90.2%; p=0.36).
• Comparable 3-month Wexner scores (4.1 for PNE vs. 4.4 for staged; p=0.74).
• Significantly lower infection rates with PNE (0.0%) compared to the staged approach (10.5%; p<0.05).

Conclusions:

• PNE is a safe and effective alternative to the staged approach for SNM in fecal incontinence.
• PNE offers comparable efficacy to the staged approach with the advantages of fewer procedures and reduced infection risk.
• The study highlights PNE's potential to improve patient experience and outcomes in SNM therapy for fecal incontinence.