Sacral nerve stimulation for faecal incontinence: long-term outcome

Aim The efficacy of sacral nerve stimulation (SNS) to treat faecal incontinence has been demonstrated in the short-and mid-term. We analysed SNS outcome in the first patients with a permanent neurostimulator in whom follow-up ranges up to 14 years. Method Of 12 patients who underwent SNS from 1994 to 1999, 9 were eligible for long-term analysis (defined as a minimum of 7 years). In 3 the device had to be removed because of pain or neurological disease. Functional outcome was monitored prospectively by standardized questionnaire. For efficacy, the recorded frequency of incontinent episodes over 2-week periods and the Wexner Score were obtained yearly after implant. Quality of life measures (FIQL scale [QoL]) were introduced in 1998. Stimulation parameter adjustments, battery longevity, and complications were documented. Results Mean follow-up in the nine patients was 9.8 years (range 7-14), over which time efficacy persisted. Clinical improvement was significant (baseline vs last follow-up): median percentage of incontinent bowel movements/week 40% (range 9-100) vs 0% (0-60%; P = 0.008), median number of incontinent episodes/week, 9 (range 2-58) vs 0 (0-29; P = 0.012); median Cleveland Clinic Score, 17 (range 12-19) vs 10 (3-14; P < 0.007); QoL improved in all categories. Pulse generator exchange was required in eight of the nine patients after a mean of 7.4 years for battery fatigue (mean 2.1 V). Complications occurred in five of the original 12 and were therapy-related, but not technique-related, in four patients. Conclusion Sacral nerve stimulation is an effective and safe long-term treatment for faecal incontinence. Clinical outcome is stable over time.