Neuromodulation for Fecal and Urinary Incontinence: Functional Results in 57 Consecutive Patients From a Single Institution

BACKGROUND: Sacral nerve stimulation is a recognized treatment for fecal and urinary incontinence. Few articles have been published about patients presenting with both types of incontinence. OBJECTIVE: The aim of this study was to report the functional results in patients operated on for simultaneous fecal and urinary incontinence by the use of sacral nerve stimulation. DESIGN: This study is a retrospective analysis of prospectively collected data. SETTINGS: The investigation was conducted in the academic departments of colorectal surgery and urology. PATIENTS: Between January 2001 and March 2010, 57 consecutive patients (54 women) with a mean age of 58 years (range, 16-76) were included. INTERVENTIONS: Two-stage sacral nerve modulation (test and implant) was performed. MAIN OUTCOME MEASURES: Functional study before testing, at 6 months, and at the end of follow-up after implantation included the use of the Cleveland Clinic incontinence score, Urinary Symptoms Profile, Fecal Incontinence Quality of Life score, and the Ditrovie score. Patient satisfaction with the technique was evaluated at a median follow-up of 62.8 months. RESULTS: Fecal incontinence improved from 14.1/20 to 7.2/20 at 6 months and 6.9/20 at the end of follow-up. Urinary incontinence, mainly urge incontinence (47% of patients), and urgency frequency (34% of patients) improved at 6 months and end of follow-up, but not retention and dysuria. Specific quality of life was improved for fecal and urinary incontinence at 6 months and end of follow-up. At the end of follow-up, 73% patients were highly satisfied with the technique, but 9% felt their condition had deteriorated. The reoperation rate was 29%, of which 12% were indicated because of a complication. LIMITATIONS: This study was limited by its retrospective nature and the multiple causes of incontinence. CONCLUSION: Fecal and urinary incontinence, studied by symptoms scores and specific quality-of-life scores, are improved in patients receiving sacral nerve stimulation for double incontinence.