Clinical efficacy of lead revisions during the test phase in sacral neuromodulation for fecal incontinence

• Published in: International journal of colorectal disease Vol. 34; no. 8; pp. 1369 - 1374
• Main Authors: Janssen, Paul T. J., Melenhorst, Jarno, Stassen, Laurents P. S., Bouvy, Nicole D., Breukink, Stephanie O.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2019; Springer; Springer Nature B.V
• Subjects: Comparative analysis; Defecation; Drug therapy; Electric Stimulation Therapy; Electrodes; Fecal incontinence; Fecal Incontinence - therapy; Feces; Gastroenterology; Hepatology; Humans; Internal Medicine; Intestine; Medicine; Medicine & Public Health; Middle Aged; Neuromodulation; Original Article; Patients; Proctology; Reoperation; Sacrum; Sacrum - physiopathology; Surgery; Treatment Outcome; Fecal incontinence; Lead revision; Sacral neuromodulation
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-019-03325-y

Background
Success rates of up to 80% have been reported for the SNM screening period in the treatment of fecal incontinence (FI). Some patients who have an unsuccessful index implantation are successfully treated with SNM after a lead revision. There is a lack of studies comparing the outcomes of successful index implantations and successful lead revision. Therefore, the results of index implantations were compared with lead revisions in a single-center cohort.
Methods
Patients treated with SNM for FI between 2008 and 2016 were retrospectively reviewed. Patients with a successful index implantation were compared with patients who underwent lead revision after SNM screening. Primary outcome was a decrease in episodes of fecal incontinence of ≥ 50% documented by a 3-week bowel habit diary.
Results
Two hundred sixty-one patients (232 index group, 29 revision group) were eligible for SNM. Two hundred thirty-one patients (208 index group, 23 revision group) received permanent SNM. Follow-up was 68.8 months for the index group and 62.2 months for the revision group. The number of episodes of FI decreased from 20.6 (SD 19.3) to 3.4 (SD 4.2) in the index group and from 12.6 (SD 5.8) to 2.0 (SD 2.3) in the revision group. This effect was maintained up to 5 and 2 years in the index and revision group, respectively. Adverse events such as loss of efficacy which required surgical intervention did not differ between the two groups.
Conclusion
Lead revision during the test phase is a valid option in patients with FI treated by SNM who suffer from loss of efficacy of the index electrode.