Affiliation:
1. Physiology Unit, St Mark's Hospital, London, UK
Abstract
Abstract
Background
Sacral nerve stimulation (SNS) is an effective treatment for faecal incontinence, but only standard stimulation parameters have been used. This study assessed the clinical impact of altering the parameters.
Methods
Twelve patients with partially improved faecal incontinence following SNS underwent acute testing to select optimal stimulation parameters; rectal compliance was used as a surrogate marker. Parameters tested were: stimulation off; frequency 14 (standard), 31 or 6·9 Hz; and pulse duration 210 (standard), 450 or 90 µs. Patients completed a 2-week bowel diary, St Mark's continence score (SMCS) and Rockwood faecal incontinence quality-of-life (FIQL) score before testing using standard settings, and after testing using optimized settings.
Results
Optimal settings, determined by greatest increase in rectal compliance, were shorter pulse width in five patients and higher frequency in seven. Optimized stimulation resulted in a decrease in mean episodes of incontinence from 2·3 to 1·2 per week (P = 0·031), soiling from 3·3 to 1·7 days per week (P = 0·016), faecal urgency from 31 to 18 per cent of all evacuations (P = 0·055) and SMCS from 12·3 to 8·7 (P = 0·008); the FIQL coping/behaviour score improved (P = 0·008).
Conclusion
With a shorter pulse width and higher frequency, clinical efficacy in patients undergoing SNS for faecal incontinence can be improved.
Publisher
Oxford University Press (OUP)
Cited by
47 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献