ABSTRACT: Depuis la première publication de Matzel et al., en 1995, rapportant l’efficacité de la stimulation des racines sacrées chez
des patients incontinents anaux, les indications, la technique de stimulation ainsi que le suivi des patients implantés ont
évolué . Cet article a pour objectif, à partir d’une revue critique de la littérature et au vu des expériences de chacun
des experts participants, de proposer une attitude consensuelle pour la prise en charge des patients incontinents anaux par
stimulation sacrée. Seront discutées: 1) les indications; 2) la technique du test temporaire; 3) la technique de l’implantation;
4) les modalités de suivi des patients; 5) la conduite à tenir en cas d’échappement thérapeutique. Nous espérons ainsi offrir
aux praticiens intéressés par la stimulation sacrée un guide pour la prise en charge des patients mais également harmoniser
nos pratiques, orienter et faciliter les travaux de recherche futurs.
Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation in patients with fecal
incontinence, the indications, contraindications and stimulation technique used, along with the follow-up of implanted patients,
have all changed . The aim of this article is to suggest a consensus of opinion on the management of patients with fecal
incontinence by sacral nerve stimulation, based on a critical review of the literature and the experience of each of the participating
experts. We will discuss: 1) indications and contraindications; 2) temporary test technique; 3) implantation technique; 4)
patient follow-up; 5) approach in case of treatment failure. We hope to provide a guide to patient management for clinical
practitioners interested in sacral nerve stimulation, and also to harmonise our practice and orient future research.
Pelvi-périnéologie 04/2012; 3(4):265-278. · 0.07 Impact Factor
ABSTRACT: Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI.
Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year.
The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome.
Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.
Colorectal Disease 03/2010; 13(6):689-96. · 2.93 Impact Factor
ABSTRACT: Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS.
Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence.
We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed.
We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.
Colorectal Disease 05/2009; 11(6):572-83. · 2.93 Impact Factor