Sacral Nerve Stimulation Takes on Tough Cases. (Fecal Incontinence, Chronic Constipation).

SAN DIEGO -- Sacral nerve stimulation appears to be highly effective for the most intractable cases of fecal incontinence and chronic constipation, Dr. Ezio Ganio reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

All candidates for implantation of a permanent sacral nerve stimulation system must first undergo a 2-week trial run involving peripheral nerve evaluation using a temporary external stimulator, said Dr. Ganio of the Colorectal Epordiensis Center, Ivrea, Italy.

He presented data from two ongoing studies by the Italian national collaborative group that maintain a prospective registry on sacral nerve stimulation. One study involved patients with intractable fecal incontinence, the other focused on severe refractory chronic constipation. The work was funded by Medtronic, developer of the Interstim neurostimulator, specialized leads, and other proprietary equipment that is utilized in sacral nerve stimulation.

Sacral nerve stimulation using Medtronic's Interstim system was approved by the Food and Drug Administration in 1997 for urinary urge incontinence and later for treatment of nonobstructive urinary retention and urinary urgency-frequency.

The Italian studies might eveptually show that this therapy can be extended to patients who have intractable fecal incontinence and are not good surgical candidates. Moreover, the success of fecal incontinence surgery is typically in the 50%-60% range.

In sacral nerve stimulation, a mild electrical stimulation is used to influence function of the bladder, perineum, external sphincter, anus, and pelvic floor.

The 2-week test phase involves implanting a temporary electrode at the S2 or S3 location of the spine; an external device provides the neurostimulation. If the clinical and manometric results obtained during ...