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01-11-2014 | Original Article

Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS)

Authors: Alexander Hotouras, Jamie Murphy, Marion Allison, Anne Curry, Norman S. Williams, Charles H. Knowles, Christopher L. Chan

Published in: Surgery Today | Issue 11/2014

Abstract

Background and purpose

Two types of neuromodulation are currently practised for the treatment of fecal incontinence (FI): sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). This study compares these therapies, as no data exist to prospectively assess their relative efficacy and costs.

Methods

The subjects of this study were two distinct cohorts undergoing SNS (between 2003 and 2008) or PTNS (2008-onwards) for FI. Clinical outcomes assessed at 3 months included incontinence scores and the number of weekly incontinence episodes. The direct medical costs for each procedure were calculated from the audited expenditure of our unit.

Results

Thirty-seven patients (94.6 % women) underwent permanent SNS and 146 (87.7 % women) underwent PTNS. The mean pre-treatment incontinence score (±SD) was greater in the SNS cohort (14 ± 4 vs. 12 ± 4) and the mean post-treatment incontinence scores were similar for the two therapies (9 ± 5 vs. 10 ± 4), with a greater effect size evident in the SNS patients. In a ‘pseudo case–control’ analysis with 37 “matched” patients, the effect of both treatments was similar. The cost of treating a patient for 1 year was £11 374 ($18 223) for permanent SNS vs. £1740 ($2784) for PTNS.

Conclusion

Given the lesser cost and invasive nature of PTNS, where both techniques are available, a trial of PTNS could be considered for all patients.

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Title: Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS)
Authors: Alexander Hotouras
Jamie Murphy
Marion Allison
Anne Curry
Norman S. Williams
Charles H. Knowles
Christopher L. Chan
Publication date: 01-11-2014
Publisher: Springer Japan
Published in: Surgery Today / Issue 11/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-014-0898-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS)

Abstract

Background and purpose

Methods

Results

Conclusion

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Abstract

Background and purpose

Methods

Results

Conclusion

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