Top

Techniques in Coloproctology

Published in:

01-12-2024 | Fecal Incontinence | Methodology

Is percutaneous tibial nerve stimulation (PTNS) effective for fecal incontinence (FI) in adults compared with sham electrical stimulation? A meta-analysis

Authors: Can Luo, Dongmei Wei, Kaiyin Pang, Ling Mei, Yueyue Chen, Xiaoyu Niu

Published in: Techniques in Coloproctology | Issue 1/2024

Abstract

Background

Sacral nerve neuromodulation (SNM) has been considered the optimal second-line treatment for fecal incontinence (FI). However, SNM involves high cost and requires highly skilled operators. Percutaneous tibial nerve stimulation (PTNS) has emerged as an alternative treatment modality for FI, yielding varying clinical outcomes. We conducted this meta-analysis to evaluate the effectiveness and safety of PTNS compared to sham electrical stimulation for FI.

Methods

PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies from May 12, 2012 to May 12, 2022.

Results

Four randomized controlled studies were included in this review, involving a total of 439 adult patients with FI (300 in the PTNS group and 194 in the sham electrical stimulation group). Our meta-analysis revealed that PTNS demonstrated superior efficacy in reducing weekly episodes of FI compared to the control groups (MD − 1.6, 95% CI − 2.94 to − 0.26, p = 0.02, I² = 30%). Furthermore, a greater proportion of patients in the PTNS group reported more than a 50% reduction in FI episodes per week (RR 0.73, 95% CI 0.57–0.94, p = 0.02, I² = 6%). However, no significant differences were observed in any domains of the FI Quality of Life (QoL) and St Mark’s incontinence scores (MD – 2.41, 95% CI – 5.1 to 0.27, p = 0.08, I² = 67%). Importantly, no severe adverse events related to PTNS were reported in any of the participants.

Conclusions

Our meta-analysis revealed that PTNS was more effective than sham stimulation in reducing FI episodes and led to a higher proportion of patients reporting more than a 50% reduction in weekly FI episodes.

Bharucha AE, Dunivan G, Goode PS et al (2015) Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol 110(1):127–136. https://doi.org/10.1038/ajg.2014.396CrossRefPubMed

Ditah I, Devaki P, Luma HN et al (2014) Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010. Clin Gastroenterolo Hepatol Off Clin Pract J Am Gastroenterol Assoc 12(4):636-643.e2. https://doi.org/10.1016/j.cgh.2013.07.020CrossRef

Menees SB, Almario CV, Spiegel BMR, Chey WD (2018) Prevalence of and factors associated with fecal incontinence: results from a population-based survey. Gastroenterology 154(6):1672-1681.e1673. https://doi.org/10.1053/j.gastro.2018.01.062CrossRefPubMed

Brown HW, Wexner SD, Segall MM, Brezoczky KL, Lukacz ES (2012) Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract 66(11):1101–1108. https://doi.org/10.1111/ijcp.12018CrossRefPubMed

Arroyo Fernández R, Avendaño Coy J, Ando Lafuente S, Martín Correa MT, Ferri Morales A (2018) Posterior tibial nerve stimulation in the treatment of fecal incontinence: a systematic review. Rev Esp Enferm Dig 110(9):577–588. https://doi.org/10.17235/reed.2018.5007/2017CrossRefPubMed

Deb B, Prichard DO, Bharucha AE (2020) Constipation and fecal incontinence in the elderly. Curr Gastroenterol Rep 22(11):54. https://doi.org/10.1007/s11894-020-00791-1CrossRefPubMed

Brown HW, Dyer KY, Rogers RG (2020) Management of fecal incontinence. Obstet Gynecol 136(4):811–822. https://doi.org/10.1097/aog.0000000000004054CrossRefPubMed

Wald A (2018) Diagnosis and management of fecal incontinence. Curr Gastroenterol Rep 20(3):9. https://doi.org/10.1007/s11894-018-0614-0CrossRefPubMed

Forte ML, Andrade KE, Lowry AC, Butler M, Bliss DZ, Kane RL (2016) Systematic review of surgical treatments for fecal incontinence. Dis Colon Rectum 59(5):443–469. https://doi.org/10.1097/dcr.0000000000000594CrossRefPubMed

10.

Brown SR, Wadhawan H, Nelson RL (2013) Surgery for faecal incontinence in adults. Cochrane Database of Syst Rev 7:CD001757. https://doi.org/10.1002/14651858.CD001757.pub4CrossRef

11.

Thin NN, Horrocks EJ, Hotouras A et al (2013) Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence. Br J Surg 100(11):1430–1447. https://doi.org/10.1002/bjs.9226CrossRefPubMed

12.

Kreydin EI, Chaudhry ZQ, Kazanjian KK, Lin AY (2019) Anal sphincteroplasty in the minimally invasive era: assessment of national trends and complications. Am Surg 85(1):46–51CrossRefPubMed

13.

Wald A, Bharucha AE, Cosman BC, Whitehead WE (2014) ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol 109(8):1141–1157. https://doi.org/10.1038/ajg.2014.190CrossRefPubMed

14.

Janssen PTJ, Komen N, Melenhorst J et al (2017) Sacral neuromodulation for fecal incontinence: a review of the central mechanisms of action. J Clin Gastroenterol 51(8):669–676. https://doi.org/10.1097/mcg.0000000000000850CrossRefPubMed

15.

Tan E, Ngo NT, Darzi A, Shenouda M, Tekkis PP (2011) Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int J Colorectal Dis 26(3):275–294. https://doi.org/10.1007/s00384-010-1119-yCrossRefPubMed

16.

Mellgren A, Wexner SD, Coller JA et al (2011) Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 54(9):1065–1075. https://doi.org/10.1097/DCR.0b013e31822155e9CrossRefPubMed

17.

Peña Ros E, Parra Baños PA, Benavides Buleje JA et al (2016) Short-term outcome of percutaneous posterior tibial nerve stimulation (PTNS) for the treatment of faecal incontinence. Tech Coloproctol 20(1):19–24. https://doi.org/10.1007/s10151-015-1380-8CrossRefPubMed

18.

Hounsome N, Roukas C (2018) Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence. Ther Adv Gastroenterol 11:1756284818802562. https://doi.org/10.1177/1756284818802562CrossRef

19.

Al Asari S, Meurette G, Mantoo S, Kubis C, Wyart V, Lehur PA (2014) Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: a comparative case-matched study. Colorectal Dis 16(11):O393-399. https://doi.org/10.1111/codi.12680CrossRefPubMed

20.

Heywood NA, Pearson JS, Nicholson JE et al (2018) The short-term effects of posterior tibial nerve stimulation on anorectal physiology in patients with faecal incontinence: a single centre experience. Ther Adv Gastroenterol 11:1756284818786111. https://doi.org/10.1177/1756284818786111CrossRef

21.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006CrossRefPubMed

22.

George AT, Kalmar K, Sala S et al (2013) Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence. Br J Surg 100(3):330–338. https://doi.org/10.1002/bjs.9000CrossRefPubMed

23.

Knowles CH, Horrocks EJ, Bremner SA et al (2015) Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet 386(10004):1640–1648. https://doi.org/10.1016/s0140-6736(15)60314-2CrossRefPubMed

24.

van der Wilt AA, Giuliani G, Kubis C, van Wunnik BPW et al (2017) Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence. Br J Surg 104(9):1167–1176. https://doi.org/10.1002/bjs.10590CrossRefPubMed

25.

Zyczynski HM, Richter HE, Sung VW et al (2022) Percutaneous tibial nerve stimulation vs sham stimulation for fecal incontinence in women: neuromodulation for accidental bowel leakage randomized clinical trial. Am J Gastroenterol 117(4):654–667. https://doi.org/10.14309/ajg.0000000000001605CrossRefPubMedPubMedCentral

26.

Norton NJ (2004) The perspective of the patient. Gastroenterology 126(1 Suppl 1):S175-179. https://doi.org/10.1053/j.gastro.2003.10.081CrossRefPubMed

27.

Goode PS, Burgio KL, Halli AD et al (2005) Prevalence and correlates of fecal incontinence in community-dwelling older adults. J Am Geriatr Soc 53(4):629–635. https://doi.org/10.1111/j.1532-5415.2005.53211.xCrossRefPubMed

28.

NICE (2011) Percutaneous tibial nerve stimulation (PTNS) for faecal incontinence.https://www.nice.org.uk/guidance/ipg395/resources/percutaneous-tibial-nerve-stimulation-for-faecal-incontinence-pdf-1899867877238725.pdf

29.

Wald A, Bharucha AE, Limketkai B et al (2021) ACG clinical guidelines: management of benign anorectal disorders. Am J Gastroenterol 116(10):1987–2008. https://doi.org/10.14309/ajg.0000000000001507CrossRefPubMed

30.

Bordeianou LG, Thorsen AJ, Keller DS et al (2023) The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of fecal incontinence. Dis Colon Rectum 66(5):647–661CrossRef

31.

Assmann SL, Keszthelyi D, Kleijnen J et al (2022) Guideline for the diagnosis and treatment of faecal incontinence-a UEG/ESCP/ESNM/ESPCG collaboration. United Eur Gastroenterol J 10(3):251–286. https://doi.org/10.1002/ueg2.12213CrossRef

32.

Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346(8983):1124–1127. https://doi.org/10.1016/s0140-6736(95)91799-3CrossRefPubMed

33.

Simillis C, Lal N, Qiu S et al (2018) Sacral nerve stimulation versus percutaneous tibial nerve stimulation for faecal incontinence: a systematic review and meta-analysis. Int J Colorectal Dis 33(5):645–648. https://doi.org/10.1007/s00384-018-2976-zCrossRefPubMed

34.

Hotouras A, Murphy J, Allison M et al (2014) Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). Surg Today 44(11):2124–2130. https://doi.org/10.1007/s00595-014-0898-0CrossRefPubMed

35.

Shafik A, Ahmed I, El-Sibai O, Mostafa RM (2003) Percutaneous peripheral neuromodulation in the treatment of fecal incontinence. Eur Surg Res 35(2):103–107. https://doi.org/10.1159/000069399CrossRefPubMed

36.

Michelsen HB, Buntzen S, Krogh K, Laurberg S (2006) Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation. Dis Colon Rectum 49(7):1039–1044. https://doi.org/10.1007/s10350-006-0548-8CrossRefPubMed

37.

Dibley L, Norton C, Cotterill N, Bassett P (2016) Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD. Eur J Gastroenterol Hepatol 28(2):233–239. https://doi.org/10.1097/meg.0000000000000513CrossRefPubMed

38.

Bedard K, Heymen S, Palsson OS, Bharucha AE, Whitehead WE (2018) Relationship between symptoms and quality of life in fecal incontinence. Neurogastroenterol Motil. https://doi.org/10.1111/nmo.13241CrossRefPubMed

39.

Bharucha AE, Knowles CH, Mack I et al (2022) Faecal incontinence in adults. Nat Rev Dis Prim 8(1):53. https://doi.org/10.1038/s41572-022-00381-7CrossRefPubMed

40.

Horrocks EJ, Chadi SA, Stevens NJ, Wexner SD, Knowles CH (2017) Factors associated with efficacy of percutaneous tibial nerve stimulation for fecal incontinence, based on post-hoc analysis of data from a randomized trial. Clin Gastroenterol Hepatol 15(12):1915-1921.e1912. https://doi.org/10.1016/j.cgh.2017.06.032CrossRefPubMed

41.

Thin NN, Taylor SJ, Bremner SA et al (2015) Randomized clinical trial of sacral versus percutaneous tibial nerve stimulation in patients with faecal incontinence. Br J Surg 102(4):349–358. https://doi.org/10.1002/bjs.9695CrossRefPubMed

42.

Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology 14:135.https://doi.org/10.1186/1471-2288-14-135

43.

Follmann D, Elliott P, Suh I, Cutler J (1992) Variance imputation for overviews of clinical trials with continuous response. Journal of clinical epidemiology 45(7):769–773.https://doi.org/10.1016/0895-4356(92)90054-q

Title: Is percutaneous tibial nerve stimulation (PTNS) effective for fecal incontinence (FI) in adults compared with sham electrical stimulation? A meta-analysis
Authors: Can Luo
Dongmei Wei
Kaiyin Pang
Ling Mei
Yueyue Chen
Xiaoyu Niu
Publication date: 01-12-2024
Publisher: Springer International Publishing
Keywords: Fecal Incontinence
Nerve Stimulation
Published in: Techniques in Coloproctology / Issue 1/2024
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-024-02910-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is percutaneous tibial nerve stimulation (PTNS) effective for fecal incontinence (FI) in adults compared with sham electrical stimulation? A meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Complications associated with loop ileostomy: analysis of risk factors

Simple technique of double-layer enterotomy closure using a bidirectional barbed suture material when performing intracorporeal side-to-side anastomosis in robot-assisted right colectomy for colon cancer

Side-to-side isoperistaltic strictureplasty (Michelassi technique) in extensive Crohn’s disease: a step-by-step video demonstration

Efferent limb stimulation prior to loop ileostomy closure: a systematic review and meta-analysis

A step-by-step guide to ileoanal J-pouch MRI interpretation

Early diverting stoma closure is feasible and safe: results from a before-and-after study on the implementation of an early closure protocol at a tertiary referral center