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Sacral nerve stimulation for faecal incontinence in patients with sacral malformation
M Brunner1, Z Cui2, K E Matzel3
1Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
International Journal of Colorectal Disease
|December 31, 2016
Summary
Sacral nerve stimulation (SNS) is effective for fecal incontinence (FI), even with sacral malformations. Preoperative imaging is recommended to ensure successful electrode placement for this common condition.
Area of Science:
- Neurology
- Gastroenterology
Background:
- Sacral nerve stimulation (SNS) is a standard treatment for fecal incontinence (FI).
- Successful SNS requires accessible sacral nerves, but electrode placement can fail due to unsuspected sacral malformations.
- Sacral malformations occur in up to 24.1% of the population.
Observation:
- This study reports on two patients with FI secondary to congenital anorectal and sacral malformations.
- Despite partial sacral agenesis, SNS was successfully implemented in both cases.
- Patients experienced significant improvements in postponing defecation, reduced incontinence episodes, and enhanced quality of life.
Findings:
- Sacral nerve stimulation (SNS) can be feasible and beneficial for fecal incontinence (FI) management, even in the presence of sacral malformations.
- Patients demonstrated at least a 50% reduction in incontinence episodes and improved ability to postpone defecation.
- Significant improvements in quality of life were observed post-SNS treatment.
Implications:
- Clinicians should consider sacral malformations as a potential cause for SNS lead placement failure in FI patients.
- Preoperative imaging, particularly MRI of the sacrum, is advisable to assess anatomy and plan for potential technical difficulties.
- Pudendal nerve stimulation is a potential alternative if sacral nerve access is technically unfeasible.
