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Lack of effect of sacral nerve stimulation for incontinence in patients with systemic sclerosis
Author(s) -
Butt S. K.,
Alam A.,
Cohen R.,
Krogh K.,
Buntzen S.,
Emmanuel A.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12969
Subject(s) - medicine , endoanal ultrasound , etiology , atrophy , sphincter , external anal sphincter , sacral nerve stimulation , connective tissue , surgery , internal anal sphincter , stimulation , rectum , anal canal , pathology
Aim Systemic sclerosis ( SS c) is a multisystem disorder of unknown aetiology leading to the deposition of excessive connective tissue in the skin, blood vessels and internal organs. Gastrointestinal involvement occurs in 90% of cases and the prevalence of faecal incontinence ( FI ) is 38%. This study comprises the largest case series assessing the efficacy of sacral nerve stimulation ( SNS ) treatment for incontinence in this patient group. Method A retrospective analysis on prospectively collected data was performed on all SS c patients from our two centres who had undergone SNS for FI . Results Ten female patients of mean age of 54 (37–72) years had temporary SNS performed. The mean duration of FI was 13 (2–25) years. All had passive FI . Each patient had preprocedure anorectal physiology and endoanal ultrasound examinations documenting internal sphincter atrophy/fragmentation or reduced anal resting pressure. Overall there was no statistically significant difference ( P = 0.57) in the total Wexner incontinence scores before (mean 15.1 ± 2.6 SD ) and during temporary SNS procedures (mean 13.1 ± 3.6 SD ). Two patients with a significant improvement went on to have permanent SNS with only one achieving a favourable outcome at 1 year. Conclusion This study showed that SNS failed to reduce episodes of leakage in nine out of 10 patients with systemic sclerosis affected with incontinence.