Long-term outcomes of sacral nerve stimulation for faecal incontinence

BackgroundSacral nerve stimulation (SNS) has proven short- to medium-term effectiveness for the treatment of faecal incontinence (FI); fewer long-term outcomes have been presented and usually in small series. Here, the long-term effectiveness of SNS was evaluated in a large European cohort of patients with a minimum of 5years' follow-up. MethodsProspectively registered data from patients with FI who had received SNS for at least 5years from ten European centres were collated by survey. Daily stool diaries, and Cleveland Clinic and St Mark's incontinence scores were evaluated at baseline, after implantation and at the last follow-up. SNS was considered successful when at least 50 per cent symptom improvement was maintained at last follow-up. ResultsA total of 407 patients underwent temporary stimulation, of whom 272 (668 per cent) had an impulse generator implanted; 228 (560 per cent) were available for long-term follow-up at a median of 84 (i.q.r. 70-113) months. Significant reductions in the number of FI episodes per week (from median 7 to 025) and summative symptom scores (median Cleveland Clinic score from 16 to 7, St Mark's score from 19 to 6) were recorded after implantation (all P <0001) and maintained in long-term follow-up. In per-protocol analysis, long-term success was maintained in 713 per cent of patients and full continence was achieved in 500 per cent; respective values based on intention-to-treat analysis were 477 and 334 per cent. Predictive analyses determined no significant association between pretreatment variables and successful outcomes. Risk of long-term failure correlated with minor symptom score improvement during the temporary test phase. ConclusionSNS remains an effective treatment for FI in the long term for approximately half of the patients starting therapy. SNS effective in half who start therapy