Suboptimal outcome following sacral nerve stimulation for faecal incontinence

Abstract

Background: The aim of the study was to identify the incidence of suboptimal therapeutic responses and adverse events associated with sacral nerve stimulation (SNS) for faecal incontinence, and to determine their influence on treatment outcome.

Methods: Prospectively collected data from 176 patients who underwent SNS were reviewed retrospectively. Patient variables and reportable events were analysed by binary regression to identify the predictors of treatment outcome.

Results: Overall, 592 reportable events were recorded from 150 patients (85·2 per cent) at a median of 11 (interquartile range (i.q.r.) 4-26) months. Loss of efficacy (212 events, 87 patients), lack of efficacy (186 events, 68 patients) and pain/discomfort (126 events, 67 patients) accounted for 88·5 per cent of reportable events. Loss of efficacy (odds ratio (OR) 2·52, 95 per cent confidence interval 1·33 to 4·79; P = 0·007), lack of efficacy (OR 2·80, 1·46 to 5·36; P = 0·002) and pain in the leg (OR 4·07, 1·34 to 12·33; P = 0·013) were predictors of unfavourable outcome in the medium to long term. At a median follow-up of 33 (i.q.r. 20-52) months, 31 patients (17·6 per cent) had explantation of the device or discontinued treatment.

Conclusion: Suboptimal therapeutic responses and adverse events are not uncommon when SNS is employed for faecal incontinence. They have a negative impact on treatment outcome.