Neuromodulación de raíces sacras en incontinencia fecal / Sacral nerve stimulation for fecal incontinence

Objetivo: analizar los resultados y complicaciones a corto plazo de nuestros primeros cincuenta pacientes con incontinencia fecal tratados mediante estimulación de raíces sacras. Pacientes: se revisan cincuenta pacientes con incontinencia fecal tratados mediante neuromodulación de raíces sacras en 4 centros hospitalarios. Las variables analizadas son: edad, sexo, tiempo de evolución de la incontinencia, causa de la incontinencia, cirugías previas para tratar la incontinencia, puntuación en la escala de Wexner, parámetros de la manometría anorrectal y los hallazgos en la ecografía endoanal. Tras la intervención se revisa la puntuación en la escala de Wexner, los parámetros en la manometría anorrectal y las complicaciones asociadas a esta técnica. Resultados: la edad media de los pacientes es de 59,9 años con predominio del sexo femenino. Las causas más frecuentes de incontinencia son obstétrica, idiopática y cirugía anal previa. El tiempo medio de seguimiento es de 17,02 meses. Tras el tratamiento se objetivó disminución en la puntuación en la escala de Wexner y aumento de la presión anal de contracción voluntaria de forma estadísticamente significativa. Hubo complicaciones menores derivadas de la técnica: 2 infecciones de herida quirúrgica que obligaron a retirar el estimulador, 2 casos de dolor que se manejaron conservadoramente, 1 superficialización del estimulador colocado en glúteo y una rotura del electrodo tetrapolar. Conclusiones: la neuromodulación de raíces sacras es una técnica sencilla que consigue una mejoría en la escala de Wexner estadísticamente significativa con una incidencia de complicaciones baja(AU)

Objective: to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation. Patients: fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed. Results: mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean followup is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode. Conclusions: sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate(AU)

Customized biofeedback therapy improves results in fecal incontinence.

BACKGROUND AND AIMS: Biofeedback therapy has been extensively used and accepted in fecal incontinence, but reports of its efficiency vary. We evaluated feedback therapy efficiency when (a) selecting the patient's subject of the therapy, and (b) customizing the therapy protocol used for each patient. PATIENTS AND METHODS: Fifty-three patients with fecal incontinence were selected for biofeedback training. The treatment program was customized for each patient depending on the underlying dysfunction, the patient's cooperative and learning attitude, and the patient's progress. Biofeedback efficiency was measured using clinical scores, subjective satisfaction of the patient, and manometry. RESULTS: Incontinent scores showed improvement in 66% of patients and good improvement in 11% and 15%, respectively, indicating an overall excellent effect of the therapy. Subjective satisfaction was strongly correlated with the previous incontinent scores. Comparison of manometry parameters before and after biofeedback therapy, including maximum anal resting, maximum anal squeeze pressure, and maximum duration of the squeeze, all showed significant differences. In addition, the sensory threshold significantly decreased after biofeedback therapy. Clinical improvements were maintained during the following 12 months. CONCLUSION: Biofeedback improves objective and subjective parameters of anorectal function. Selection of patients and customization of the therapy program increased biofeedback efficiency for the treatment of fecal incontinence.