Edenfield Autumn L, Amundsen Cindy L, Wu Jennifer M, Levin Pamela J, Siddiqui Nazema Y
Assistant Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
Professor, Department of Obstetrics and Gynecology, Duke University, Durham, NC.
Obstet Gynecol Surv. 2015 May;70(5):329-41. doi: 10.1097/OGX.0000000000000171.
Posterior tibial nerve stimulation (PTNS) is a potential emerging therapy for fecal incontinence (FI). The aim of this study was to systematically review the literature regarding the efficacy of PTNS as a treatment of FI.
We searched MEDLINE/PubMed, EMBASE, and Cochrane databases from inception through November 2013. We included English-language full-text articles reporting outcomes for FI with either percutaneous PTNS or transcutaneous techniques (transcutaneous electrical nerve stimulation). We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to assess study quality.
Our search yielded 1154 citations; 129 abstracts and 17 articles were included for full-text review. There were 13 case series and 4 randomized controlled trials. Fifteen studies were of low quality, none were of fair quality, and 2 studies were of good quality based on the Grades of Recommendation, Assessment, Development, and Evaluation system. In total, 745 subjects were studied, and of those, 90% were women and 10% were men. Studies involved percutaneous PTNS in 57% (428/745) of the subjects, transcutaneous electrical nerve stimulation in 30% (223/745), and sham technique in 13% (94/745). Therapy frequency, maintenance therapy, and follow-up time varied across studies. Eleven studies assessed FI episodes and bowel movement deferment time; all but 1 showed statistical improvement after therapy. Ten of the 11 studies that used the Cleveland Clinic Florida Fecal Incontinence score reported statistically significantly improved scores after treatment.
Multiple low-quality studies show improvement in FI after PTNS. High-quality studies with comparison groups and clinically meaningful outcome measures would further establish the utility of PTNS for FI.
胫后神经刺激术（PTNS）是一种潜在的新兴粪便失禁（FI）治疗方法。本研究的目的是系统回顾关于PTNS治疗FI疗效的文献。
我们检索了MEDLINE/PubMed、EMBASE和Cochrane数据库，检索时间从建库至2013年11月。我们纳入了报告经皮PTNS或经皮技术（经皮电神经刺激）治疗FI结果的英文全文文章。我们使用推荐分级、评估、制定与评价（GRADE）系统评估研究质量。
我们的检索产生了1154条引文；129篇摘要和17篇文章被纳入全文审查。有13个病例系列和4项随机对照试验。根据推荐分级、评估、制定与评价系统，15项研究质量低，没有一项质量中等，2项研究质量高。总共研究了745名受试者，其中90%为女性，10%为男性。研究中57%（428/745）的受试者采用经皮PTNS，30%（223/745）采用经皮电神经刺激，13%（94/745）采用假手术技术。各研究的治疗频率、维持治疗和随访时间各不相同。11项研究评估了FI发作次数和排便延迟时间；除1项研究外，所有研究均显示治疗后有统计学意义的改善。11项使用佛罗里达克利夫兰诊所粪便失禁评分的研究中有10项报告治疗后评分有统计学意义的显著改善。
多项低质量研究表明PTNS治疗后FI有改善。采用对照组和具有临床意义的结局指标的高质量研究将进一步确定PTNS对FI的效用。
