Pudendal neuropathy patients called good candidates for artifical sphincter. (Intractable Fecal Incontinence).

ST. LOUIS -- An artificial sphincter for intractable fecal incontinence provides impressive quality of life benefits--when implanted in the right patients.

Who's a good candidate? Far and away the largest pool consists of patients with pudendal neuropathy.

"Let's face it--it doesn't do us any good to bring muscle back together [in a sphincteroplasty] if there's no nerve going to the muscle," Dr. Wayne B. Tuckson said at the 12th International Pelvic Reconstructive and Vaginal Surgery Conference.

Candidates should also be ambulatory--after all, they still have to get to the bathroom--have good mental status, be without major comorbid illness, and be free of arthritis of the hands that would interfere with use of the device's small implanted hand pump. Chronic diarrhea or constipation must be corrected before the Acticon neosphincter goes in, explained Dr. Tuckson, a colorectal surgeon at the University of Louisville (Ky).

A multicenter cohort study has demonstrated that placement of American Medical Systems' Acticon neosphincter led to a reduction in standardized fecal incontinence scores from a mean of 106 preoperatively to 25. Resting anal-canal pressure improved from 28 mm Hg preoperatively to 60 mm Hg upon device activation.

Only 11% of participants were able to defer defecation preoperatively, compared with more than 80% postoperatively. Perhaps most impressive was the finding that more than 70% of patients rated their quality of life favorably following receipt of the Acticon neosphincter, compared with just 19% before.

The Acticon ...