Eggers Erica, Crouss Tess, Beausang Jasjit, Smith Devon, Spector Sean, Saracco Benjamin, Adams Amanda, Dickinson Taylor, Lipetskaia Lioudmila
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ, USA.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ, USA.
Neuromodulation. 2025 Jul;28(5):715-726. doi: 10.1016/j.neurom.2024.06.504. Epub 2024 Aug 17.
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.
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.
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%.
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.
骶神经刺激（SNS）现已用于治疗大便失禁（FI）超过20年。本系统评价的目的是确定SNS治疗FI的长期疗效。
全面检索MEDLINE、Embase和Cochrane Central数据库以查找相关出版物，排除病例报告，纳入随访时间≥36个月的成人SNS治疗FI的研究结果报告。使用非随机干预研究中的偏倚风险工具评估偏倚。根据报告的与FI相关的症状严重程度和生活质量结果进行数据汇总。
共识别出3326篇出版物，纳入了36项研究，共3770名受试者。所有研究均存在严重偏倚风险。每项出版物对成功的定义各不相同，按方案分析的成功率为59.4%至87.5%，意向性分析的成功率为20.9%至87.5%。所有报告排便日记数据、圣马克评分和克利夫兰诊所失禁评分的研究均表明，长期SNS治疗有显著改善。评估生活质量结果的研究也均显示，根据大便失禁生活质量量表测量，生活质量有所改善。总体翻修率为35.2%，取出率为19.7%。
≥36个月时客观和主观结果的改善支持使用SNS长期治疗FI。由于缺乏对照试验以及纳入研究的异质性，这些数据的解释受到限制。
