Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence?
Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence?
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DOI：
10.1308/003588410x12628812459652
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发表时间：
2010-07-01
影响因子：
1.4
通讯作者：
Maxwell-Armstrong, Charles
中科院分区：
文献类型：
--
作者：
Findlay, John M.;Yeung, Justin M. C.;Maxwell-Armstrong, Charles
前言大便失禁是一种普遍和重要的条件，有一系列的治疗方案。通过骶神经刺激器进行神经调节是有效的，但昂贵，并且与器械植入引起的并发症相关。通过胫后神经刺激（PTNS）的外周神经调节已在尿失禁中进行了评估，但其用于大便失禁的证据很少，也没有来自英国的文献。这一回顾性研究旨在评估PTNS在faecal incontinence.PATIENTS和METHODS连续13例女性患者大便失禁的各种原因（9特发性，3产科，1手术）进行PINS在英国医院的疗效。所有人都接受了结肠成像、肛门直肠生理学和肛门内超声检查。既往治疗包括物理治疗（13例）、括约肌成形术（3例）、生物反馈（3例）和PTQ植入物（1例）。结果经PTNS治疗12周后，平均每月风、液、固体性尿失禁发作次数分别由6、10、18次降至0次（P < 0.05）;生活质量指数也有显著改善。在1个月的随访中，持续减少失禁的风（0集），与非显着减少液体和固体粪便。结论PTNS是一种潜在的有效的，技术上简单，微创的替代治疗方式大便失禁。这些早期的结果是令人鼓舞的，但我们还在等待中长期的随访，以及一个更大的随机试验，比较PTNS与替代治疗和安慰剂。
INTRODUCTION Faecal incontinence is a prevalent and important condition, with a range of treatment options. Neuromodulation via sacral nerve stimulators is efficacious, but expensive and associated with complications due to device implantation. Peripheral neuromodulation via posterior tibial nerve stimulation (PTNS) has been assessed in urinary incontinence, but there is minimal evidence for its use in faecal incontinence and no literature from the UK. This retrospective review aimed to assess the efficacy of PTNS in faecal incontinence.PATIENTS AND METHODS Thirteen consecutive female patients with faecal incontinence of various causes (9 idiopathic, 3 obstetric, 1 surgery) underwent PINS at a UK hospital. All were investigated with colonic imaging, anorectal physiology and endo-anal ultrasound. Prior treatments included physiotherapy (13), sphincteroplasty (3) biofeedback (3) and PTQ implants (1). PTNS was performed for 30 min, weekly for 12 weeks.RESULTS Median monthly episodes of incontinence of wind, liquid and solid reduced from 6, 10 and 18 respectively to 0 with 12 weeks' treatment (P < 0.05). Significant improvements in quality of life indices were also seen. At 1-month follow up, a sustained reduction in incontinence of wind was seen (0 episodes), with non-significant reductions of liquid and solid stool.CONCLUSIONS PTNS is a potentially efficacious, technically simple and minimally invasive alternative treatment modality for faecal incontinence. These early results are encouraging, but we await medium- and long-term follow-up, and a larger randomised trial comparing PTNS with alternative treatments and placebo.