AI Article Synopsis
- Sacral nerve stimulation (SNS) has been used for over 20 years to treat fecal incontinence and this review aims to evaluate its long-term effectiveness over a follow-up period of at least 36 months.
- A total of 36 studies involving 3770 participants were analyzed, though all studies showed a serious risk of bias, and success rates varied widely, indicating that while SNS typically improves symptoms and quality of life, definitions of success differ across studies.
- Despite significant improvements in symptoms and quality of life reported, the findings are limited due to inconsistent study designs and a lack of comparative trials, with a notable revision rate of 35.2% and explantation rate of 19.7%.
Article Abstract
Introduction: Sacral nerve stimulation (SNS) has now been used as a treatment for fecal incontinence (FI) for >20 years. The aim of this systematic review was to determine the long-term efficacy of SNS on the treatment of FI.
Materials And Methods: A comprehensive search of the MEDLINE, Embase, and Cochrane Central data bases was performed to find publications, excluding case reports, reporting outcomes of SNS treatment for FI in adults with ≥36 months of follow-up. Bias was assessed using the Risk of Bias in Non-randomized Studies-of Interventions tool. Data were summarized per reported FI-related outcomes for symptom severity and quality of life.
Results: In total, 3326 publications were identified, and 36 studies containing 3770 subjects were included. All studies had a serious risk of bias. Success was variably defined by each publication and ranged from 59.4% to 87.5% for per-protocol analyses and 20.9% to 87.5% for intention-to-treat analyses. All studies reporting bowel diary data, St Mark's scores, and Cleveland Clinic Incontinence Scores indicated significant improvement with SNS treatment in the long term. Studies that evaluated quality-of-life outcomes also all showed improvements in quality of life as measured by the Fecal Incontinence Quality of Life Scale. The aggregate revision rate was 35.2%, and the explantation rate was 19.7%.
Conclusions: Improvements in objective and subjective outcomes at ≥36 months support using SNS for the long-term treatment of FI. Interpretation of these data is limited by a lack of comparative trials and heterogeneity of the included studies.
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| http://dx.doi.org/10.1016/j.neurom.2024.06.504 | DOI Listing |
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