Humphrey Atiemo, Ashwin Vaze, Courtney Moore, Sarah McAchran, Joseph Abdelmalak, Howard Goldman, Sandip Vasavada, and Raymond Rackley

Section of Female Urology, Glickman Urological Institute, Cleveland, OH

Introduction: Sacral neuromodulation (SNM) has been shown to be an effective treatment for voiding dysfunction (VD). Fecal incontinence may co-exist in 40% of VD cases and represents another aspect of pelvic floor dysfunction with few effective therapies outside of diverting colostomy. This pilot study aims to identify the efficacy of SNM in the treatment of fecal incontinence in patients presenting with concomitant VD.

Methods: A cohort of 281 female patients with VD undergoing SNM therapy was identified from a single center, multi-physician database. Females with VD +/- fecal incontinence were identified as cases and controls respectively. Relative risk for Stage I SNM success and Stage II explantation in the fecal incontinence group was calculated using multivariate analysis for a retrospective cohort study. Patient Global Assessment Scores for severity and improvement (PGII, PGIS) of symptoms were obtained.

Results: Twenty-six individuals with voiding dysfunction and fecal incontinence were identified. A statistical difference in parity was identified between the two cohorts (Table 1a). Stage I success rates and Stage II explant rates for the fecal incontinence groups were 88% and 9.5% respectively (Table 1b). When compared to controls, no statistical difference was identified. Using a multivariate model, a history of fecal incontinence was not a predictive factor or SNM explantation. At a 50% percent survey response rate, eight out of 12 patients (66%) reported and improvement in fecal incontinence symptoms. Seven of 12 patients (58%) reported either mild to normal status in terms of fecal incontinence severity. One patient with failure of SNM proceeded to have and end colostomy.

Conclusion: Similar efficacy is achieved with SNM in VD patients with
concomitant fecal incontinence as compared with controls. Significant patient satisfaction indicates that SNM appears to provide another therapeutic option for patients with complex pelvic floor dysfunction. Replication of this data and prospective trials comparing SNM in the setting of other pelvic health conditions that include fecal incontinence will better determine the role of SNM in the treatment of this disorder.

UroToday.com Coverage of SUFU 2007

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