Outcomes of Implementation of Sacral Nerve Stimulation in Incontinent Patients in Shiraz


Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Fecal incontinence is a common disorder in old age; however, it may not threaten life, but it can cause morbidity and many problems. Sacral nerve stimulation (SNS) is a minimally invasive surgical procedure performed by chronic electrical stimulation of the nerves in the sacral plexus through a lead implanted at the S3 foramen. This study aimed to evaluate the outcomes of SNS in Shiraz. Materials and Methods: Data from patients who underwent implantation of an SNS device from 2012 to 2018 were reviewed in Shiraz. Thirty patients who had incontinence were evaluated by a committee. Pre- and postoperative assessments of the severity of incontinence were performed using Wexner Incontinence Score. Statistical analysis was performed using paired t-test. Results: Twenty-seven patients proceeded to insertion in the temporary SNS, and of these, 16 were elected to have a permanent SNS. Finally, seven patients were satisfied with their treatment. There was a significant reduction in the pre- and post-SNS Wexner Incontinence Scores from a median of 15–10, respectively (P < 0.05). Conclusion: In our study, 16 patients underwent SNS protocol, and 43.7% of them showed a good response and recovered. It is recommended as a method for the treatment of fecal incontinence. Permanent SNS is effective, showing a significant improvement in fecal incontinence scores.


Malouf AJ, Chambers MG, Kamm MA. Clinical and economic evaluation of surgical treatments for faecal incontinence. Br J Surg 2001;88:1029-36.  Back to cited text no. 1
Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology 2004;126:S14-22.  Back to cited text no. 2
Jarrett ME, Varma JS, Duthie GS, Nicholls RJ, Kamm MA. Sacral nerve stimulation for faecal incontinence in the UK. Br J Surg 2004;91:755-61.  Back to cited text no. 3
Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995;346:1124-7.  Back to cited text no. 4
Carrington EV, Knowles CH. The influence of sacral nerve stimulation on anorectal dysfunction. Colorectal Dis 2011;13 Suppl 2:5-9.  Back to cited text no. 5
Jarrett ME, Mowatt G, Glazener CM, Fraser C, Nicholls RJ, Grant AM, et al. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 2004;91:1559-69.  Back to cited text no. 6
Wexner SD, Coller JA, Devroede G, Hull T, McCallum R, Chan M, et al. Sacral nerve stimulation for fecal incontinence: Results of a 120-patient prospective multicenter study. Ann Surg 2010;251:441-9.  Back to cited text no. 7
Ratto C, Litta F, Parello A, Donisi L, Doglietto GB. Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair. Dis Colon Rectum 2010;53:264-72.  Back to cited text no. 8
George AT, Kalmar K, Panarese A, Dudding TC, Nicholls RJ, Vaizey CJ, et al. Long-term outcomes of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2012;55:302-6.  Back to cited text no. 9
Lim JT, Hastie IA, Hiscock RJ, Shedda SM. Sacral nerve stimulation for fecal incontinence: Long-term outcomes. Dis Colon Rectum 2011;54:969-74.  Back to cited text no. 10
Hetzer FH. Fifteen years of sacral nerve stimulation: From an open procedure to a minimally invasive technique. Colorectal Dis 2011;13 Suppl 2:1-4.  Back to cited text no. 11
Ripetti V, Caputo D, Ausania F, Esposito E, Bruni R, Arullani A, et al. Sacral nerve neuromodulation improves physical, psychological and social quality of life in patients with fecal incontinence. Tech Coloproctol 2002;6:147-52.  Back to cited text no. 12
Fariello JY, Whitmore K. Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J 2010;21:1553-8.  Back to cited text no. 13
Abdel-Halim MR, Crosbie J, Engledow A, Windsor A, Cohen CR, Emmanuel AV, et al. Temporary sacral nerve stimulation alters rectal sensory function: A physiological study. Dis Colon Rectum 2011;54:1134-40.  Back to cited text no. 14
Griffin KM, Pickering M, O'Herlihy C, O'Connell PR, Jones JF. Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model. Br J Surg 2011;98:1160-9.  Back to cited text no. 15
Boyle DJ, Murphy J, Gooneratne ML, Grimmer K, Allison ME, Chan CL, et al. Efficacy of sacral nerve stimulation for the treatment of fecal incontinence. Dis Colon Rectum 2011;54:1271-8.  Back to cited text no. 16
Uludag OD, Baeten CG. Sacral neuromodulation for faecal incontinence. Dis Colon Rectum 2002;45:A34-6.  Back to cited text no. 17
Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology 2001;121:536-41.  Back to cited text no. 18
Leroi AM, Michot F, Grise P, Denis P. Effect of sacral nerve stimulation in patients with fecal and urinary incontinence. Dis Colon Rectum 2001;44:779-89.  Back to cited text no. 19
Devroede G, Giese C, Wexner SD, Mellgren A, Coller JA, Madoff RD, et al. Quality of life is markedly improved in patients with fecal incontinence after sacral nerve stimulation. Female Pelvic Med Reconstr Surg 2012;18:103-12.  Back to cited text no. 20
Hetzer FH, Hahnloser D, Clavien PA, Demartines N. Quality of life and morbidity after permanent sacral nerve stimulation for fecal incontinence. Arch Surg 2007;142:8-13.  Back to cited text no. 21
Matzel KE. Sacral nerve stimulation for faecal incontinence: Its role in the treatment algorithm. Colorectal Dis 2011;13 Suppl 2:10-4.  Back to cited text no. 22