Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University London, Whitechapel, London, United Kingdom.
Dis Colon Rectum. 2013 Jul;56(7):915-20. doi: 10.1097/DCR.0b013e31827f0697.
Percutaneous tibial nerve stimulation and sacral nerve stimulation are both second-line treatments for fecal incontinence, but the comparative efficacy of the 2 therapies is unknown. In our institution, patients with refractory fecal incontinence are generally treated with percutaneous tibial nerve stimulation before being considered for sacral nerve stimulation.
The aim of this study was to assess the outcome associated with this treatment algorithm in order to guide future management strategies.
All patients with fecal incontinence treated over a 3-year period with tibial nerve stimulation before receiving sacral nerve stimulation were identified from a prospectively recorded database. Demographics and pretreatment anorectal physiological data were available for all patients.
This study was conducted at an academic colorectal unit in a tertiary center.
Twenty patients (17 female:3 male, median age 55 (33-79) years) were identified to be refractory to percutaneous tibial nerve stimulation.
Clinical outcome data were collected prospectively before and after treatment, including 1) Cleveland Clinic Florida-Fecal Incontinence scores and 2) number of incontinence episodes per week.
The mean (±SD) pretreatment incontinence score (11.7 ± 3.5) did not differ from the mean incontinence score after 12 sessions of tibial nerve stimulation (10.9 ± 3.6, p = 0.42). All patients were subsequently counseled for sacral nerve stimulation, and 68.4% of them reported a significant therapeutic benefit with an improved incontinence score (7.7 ± 4.1, p = 0.014).
This was a nonrandomized study with a relatively small number of patients
Sacral nerve stimulation appears to be an effective treatment for patients who do not gain an adequate therapeutic benefit from percutaneous tibial nerve stimulation and, thus, should be routinely considered for this patient cohort.
经皮胫神经刺激和骶神经刺激都是治疗粪便失禁的二线治疗方法，但这两种治疗方法的疗效比较尚不清楚。在我们医院，一般对难治性粪便失禁患者先进行经皮胫神经刺激治疗，然后再考虑骶神经刺激治疗。
本研究旨在评估这种治疗方案的结果，以便为今后的管理策略提供指导。
从一个前瞻性记录的数据库中确定了在接受骶神经刺激之前接受胫神经刺激治疗的 3 年内所有患有粪便失禁的患者。所有患者均有肛门直肠生理数据。
本研究在一家三级中心的学术肛肠单位进行。
共确定了 20 名（17 名女性：3 名男性，中位年龄 55（33-79）岁）对经皮胫神经刺激有反应的患者。
治疗前后前瞻性收集临床结局数据，包括 1）克利夫兰诊所佛罗里达粪便失禁评分和 2）每周失禁发作次数。
治疗前平均（±SD）失禁评分（11.7 ± 3.5）与经 12 次胫神经刺激后的平均失禁评分（10.9 ± 3.6，p = 0.42）无差异。所有患者随后均接受了骶神经刺激治疗，其中 68.4%的患者报告治疗效果显著，失禁评分改善（7.7 ± 4.1，p = 0.014）。
这是一项非随机研究，患者数量相对较少。
骶神经刺激似乎是对经皮胫神经刺激治疗效果不佳的患者的有效治疗方法，因此应常规考虑将其用于该患者群体。
