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Int J Colorectal Dis. 2018 May;33(5):645-648. doi: 10.1007/s00384-018-2976-z. Epub 2018 Feb 22.

Sacral nerve stimulation versus percutaneous tibial nerve stimulation for faecal incontinence: a systematic review and meta-analysis.

Author information

1
Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Fulham Road, London, UK.
2
Department of Surgery and Cancer, Imperial College, London, UK.
3
Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London, UK.
4
Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore. emile.john.tan.k.w@singhealth.com.sg.

Abstract

AIMS:

Percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) are both second-line treatments for faecal incontinence (FI). To compare the clinical outcomes and effectiveness of SNS versus PTNS for treating FI in adults.

METHOD:

A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify studies comparing SNS and PTNS for treating FI. A risk of bias assessment was performed using The Cochrane Collaboration's risk of bias tool. A random effects model was used for the meta-analysis.

RESULTS:

Four studies (one randomised controlled trial and three nonrandomised prospective studies) reported on 302 patients: 109 underwent SNS and 193 underwent PTNS. All included studies noted an improvement in symptoms after treatment, without any significant difference in efficacy between SNS and PTNS. Meta-analysis demonstrated that the Wexner score improved significantly with SNS compared to PTNS (weighted mean difference 2.27; 95% confidence interval 3.42, 1.12; Pā€‰<ā€‰0.01). Moreover, SNS was also associated with a significant reduction in FI episodes per week and a greater improvement in the Fecal Incontinence Quality of Life coping and depression domains, compared to PTNS on short-term follow-up. Only two studies reported on adverse events, reporting no serious adverse events with neither SNS nor PTNS.

CONCLUSION:

Current evidence suggests that SNS results in significantly improved functional outcomes and quality of life compared to PTNS. No serious adverse events were identified with either treatment. Further, high-quality, multi-centre randomised controlled trials with standardised outcome measures and long-term follow-up are required in this field.

KEYWORDS:

Faecal incontinence; Meta-analysis; Neuromodulation; Percutaneous tibial nerve stimulation; Sacral nerve stimulation; Systematic review

PMID:
29470730
DOI:
10.1007/s00384-018-2976-z
[Indexed for MEDLINE]

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