Abstract

Sacral nerve stimulation is a treatment option for severe, medically refractory fecal incontinence, although its use in patients with anatomic abnormalities remains controversial.To determine if patients with rectoanal intussusception achieve similar benefits from device implantation to patients without rectoanal intussusception.Retrospective review of a prospectively maintained database. Demographics and clinical data were collected for each patient, including pre-operative pelvic floor testing. Defecographies were re-analyzed in a blinded fashion. Pre-operative rectoanal intussusception was determined based on the Oxford system (grade III-IV vs. not; grade V excluded).Academic-affiliated pelvic health center.All patients undergoing sacral nerve stimulation for fecal incontinence between July 2011 and July 2019.Cleveland Clinic Florida Incontinence/Wexner Scores, Fecal Incontinence Severity Indices, Fecal Incontinence Quality of Life Indices at 1 year.169 patients underwent sacral nerve stimulation for fecal incontinence during the study period. The average age was 60.3 years old and 91% were female. Forty-six patients (27.2%) had concomitant rectoanal intussusception (38 [22.5%] grade III and 8 [4.7%] grade IV). Before surgery, patients reported an average of 10.8 accidents per week and a Wexner score of 15.7 with no difference between patients with and without rectoanal intussusception (p = 0.22 and 0.95). At 1 year after surgery, the average Wexner score was 9.5. There was no difference in post-operative Wexner scores (10.4 vs. 9.2, p = 0.23) or improvement over time between patients with and without rectoanal intussusception (-6.7 vs. -5.7, p = 0.40). Similarly, there was no difference in quality of life or frequency of incontinence to liquid or solid stool.Single institution, moderate sample size, incomplete survey response.Concomitant rectoanal intussusception does not appear to affect clinical outcomes or quality of life after sacral nerve stimulation for fecal incontinence. Appropriate patients with fecal incontinence and rectoanal intussusception can be considered for sacral nerve stimulation placement.

View details for DOI 10.1097/DCR.0000000000002685

View details for PubMedID 36989066