Faecal incontinence and the role of percutaneous tibial nerve stimulation

Abstract

Aims and objectives This thesis aimed to assess the efficacy of percutaneous tibial nerve stimulation (PTNS) in the treatment of adults with faecal incontinence (FI). The objectives were (1) to perform a systematic review of the evidence base for tibial nerve stimulation (TNS) to treat FI, (2) to assess the short term efficacy of PTNS in the treatment of FI (the CONFIDeNT Trial), (3) to identify factors predictive of successful PTNS and (4) to analyse the 1-year outcomes of all patients in the CONFIDeNT Trial. Methods Objective 1: A systematic review of the current literature on TNS in the treatment of FI was performed. Objective 2: A multi-centre double blind randomised sham-controlled trial comparing PTNS to sham electrical stimulation in the treatment of adults with FI was performed. Objective 3: Logistic regression analysis to identify factors predictive of successful PTNS from the CONFIDeNT Study data was performed. Objective 4: A 1-year follow-up study of patients enrolled in The CONFIDeNT Study was performed. Results Data supporting the use of PTNS in the treatment of adults with FI was encouraging, however data quality was poor. In the short term, PTNS did not offer significant clinical benefit over sham electrical stimulation in the treatment of adults with FI, based on the primary outcome (treatment success was defined as ≥50% reduction in weekly FI episodes). Logistic regression analysis demonstrated the absence of any difficulty with rectal evacuation was the only factor predictive of successful PTNS in the short term (directly after treatment). The follow-up study demonstrated the continued benefit of treatment in the proportion of patients followed to 1-year. Conclusions PTNS should not be recommended as a first-line treatment for unselected adults with FI (the population in CONFIDeNT Trial). However, subgroups of patients, e.g. those with FI uncomplicated by problems with rectal evacuation, may benefit more. In patients gaining benefit, this appears to be sustained.