• Galal El-Gazzaz, Massarat Zutshi, Levilester Salcedo, Jeff Hammel, Raymond Rackley, and Tracy Hull.
• Department of Colorectal Surgery A30, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
• Int J Colorectal Dis. 2009 Dec 1; 24 (12): 1377-81.

PurposeThe purpose of this study was to evaluate improvement in symptoms of fecal incontinence (FI) in a group of women who also had urinary incontinence (UI) and were successfully implanted with the sacral neuromodulation (SNM) device primarily for urinary incontinence in one US institution.MethodsTwenty-four patients with FI and UI who failed to improve with conservative or standard surgical treatment underwent permanent SNM after a successful peripheral nerve stimulation test during 2003-2007. Wexner incontinence score, fecal incontinence quality of life (FIQL), and Bristol stool scales were recorded before and after treatment. Follow-up was done by questionnaires contact.ResultsTwenty-four patients (mean age 56.5 +/- 5.3 years) were studied. The median follow-up was 28 months (range 3-49). Twenty-two patients (92%) were contacted. Seven patients (31.8%) experienced improvement in both urinary and fecal incontinence symptoms. Twelve patients (54.5%) experienced no improvement in FI symptoms after SNM. Four patients required a colostomy or ileostomy; four had the system explanted (two, due to a faded clinical response and two, due to infection); and four other patients experienced no improvement after SNM. The outcomes of ten patients (45.5%) with functioning SNM were reviewed. There were significant improvement of FI symptoms with a significantly lower Wexner score from 12.0 +/- 2.0 before SNM to 4.7 +/- 3.6 (p = 0.009). The mean FIQL scores improved significantly from the baseline score 7.8 +/- 0.8 before SNM to 13.5 +/- 2.6 (p = 0.009). Bristol stool form scale was reduced significantly from 4.5 to 3.5 after SNM (p = 0.02).ConclusionsSNM may be beneficial in selected female patients with UI associated with FI. Prospective trials may help delineate which patients will show FI improvement in this combined group.

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