Sacral nerve stimulation versus percutaneous tibial nerve stimulation for faecal incontinence: a systematic review and meta-analysis

  • Constantinos Simillis
  • Nikhil Lal
  • Shengyang Qiu
  • Christos Kontovounisios
  • Shahnawaz Rasheed
  • Emile Tan
  • Paris P. Tekkis
Short Communication
  • 145 Downloads

Abstract

Aims

Percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) are both second-line treatments for faecal incontinence (FI). To compare the clinical outcomes and effectiveness of SNS versus PTNS for treating FI in adults.

Method

A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify studies comparing SNS and PTNS for treating FI. A risk of bias assessment was performed using The Cochrane Collaboration’s risk of bias tool. A random effects model was used for the meta-analysis.

Results

Four studies (one randomised controlled trial and three nonrandomised prospective studies) reported on 302 patients: 109 underwent SNS and 193 underwent PTNS. All included studies noted an improvement in symptoms after treatment, without any significant difference in efficacy between SNS and PTNS. Meta-analysis demonstrated that the Wexner score improved significantly with SNS compared to PTNS (weighted mean difference 2.27; 95% confidence interval 3.42, 1.12; P < 0.01). Moreover, SNS was also associated with a significant reduction in FI episodes per week and a greater improvement in the Fecal Incontinence Quality of Life coping and depression domains, compared to PTNS on short-term follow-up. Only two studies reported on adverse events, reporting no serious adverse events with neither SNS nor PTNS.

Conclusion

Current evidence suggests that SNS results in significantly improved functional outcomes and quality of life compared to PTNS. No serious adverse events were identified with either treatment. Further, high-quality, multi-centre randomised controlled trials with standardised outcome measures and long-term follow-up are required in this field.

Keywords

Faecal incontinence Neuromodulation Sacral nerve stimulation Percutaneous tibial nerve stimulation Systematic review Meta-analysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

384_2018_2976_MOESM1_ESM.pdf (34 kb)
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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Constantinos Simillis
    • 1
    • 2
    • 3
  • Nikhil Lal
    • 1
    • 2
  • Shengyang Qiu
    • 1
    • 2
  • Christos Kontovounisios
    • 1
    • 2
  • Shahnawaz Rasheed
    • 2
    • 3
  • Emile Tan
    • 4
  • Paris P. Tekkis
    • 1
    • 2
    • 3
  1. 1.Department of Colorectal SurgeryChelsea and Westminster Hospital NHS Foundation TrustLondonUK
  2. 2.Department of Surgery and CancerImperial CollegeLondonUK
  3. 3.Department of Colorectal SurgeryRoyal Marsden HospitalLondonUK
  4. 4.Department of Colorectal Surgery, Singapore General HospitalAcademiaSingaporeSingapore

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