THE CLINICAL EFFECTS OF NEUROMODULATION THERAPIES IN THE TREATMENT OF FAECAL INCONTINENCE
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Background and Aims
Sacral nerve stimulation (SNS) is an established therapy for faecal
incontinence (FI). Percutaneous tibial nerve stimulation (PTNS) is a newer,
less-invasive treatment. The effectiveness, cost and acceptability of these
treatments have not been systematically compared.
Methods
A systematic review of neuromodulation interventions for FI and an
investigator-blinded, randomised pilot trial of PTNS vs. SNS including parallel
quantitative (clinical outcomes and cost) and qualitative studies.
Results
The systematic review determined on intention-to-treat, the median success
rates for SNS were 63% (range 33-66%), 58% (range 52-81%) and 54%
(range 50-58%) in the short, medium and long terms respectively. The
success rate for PTNS was 59% at 12 months. In the pilot trial: 40 patients
(39 female; mean age 59 years) met eligibility criteria. As designed, 23 were
randomised to receive SNS and 17 PTNS. 15 patients progressed to
permanent SNS implantation and 16 patients received a full course of PTNS.
Within group effect sizes were marginally greater for SNS than PTNS on
available case analysis. FI episodes per week at baseline, 3 months and 6
months follow-up: SNS median 5.75 (IQR 5.75-15.5 ) [mean 11.4 (SD 12.0)],
2.5 (2-4.5) [4.0 (4.0)], 1.75 (1.5-5) [4.9 (6.9)], vs. PTNS median 6.5 (IQR 2.5-
16.5) [mean 10.6 (SD 11.2)], 3.5 (0.75-7.25) [5.8 (6.9)], 2.5 (0.75-10.75) [6.3
(6.9)]. At least 50% improvement in FI episodes per week at 6 months: SNS
61% vs. PTNS 47%. Effect estimates for SNS with chronic implanted
stimulation were larger (67% at 6 months). Clinical FI scores and quality of life
improvements complemented these results. Qualitative analysis
demonstrated a very high acceptability and safety profile for both treatments.
Total costs were £2,906 (SD £122) per patient for PTNS and £12,748 (SD
£4,175) for SNS.
Conclusions
Definitive trial data between SNS or PTNS is lacking. This RCT pilot study
determined that in the short-term, SNS confers a small clinical benefit over
PTNS for FI but is much more expensive.
Authors
Thin, Noel N.K.S.Collections
- Theses [4099]