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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2023, Number 2

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Rev Mex Coloproctol 2023; 19 (2)

Clinical and quality of life benefits in fecal incontinence following transcutaneous neurostimulation of the posterior tibial nerve: a prospective single-arm study from a mexican reference center

M AF, W CM, A VJ, A PM, E SL, C VL, G GG, Hernández F, Gomar J, M MV

Language: Spanish
References: 34
Page: 45-51
PDF size: 226.97 Kb.


ABSTRACT

Introduction: fecal incontinence is a multifactorial condition that has a profound impact not only on evacuation rhythm, but also on patient's quality of life. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a safe option for the treatment of patient with fecal incontinence, especially in developing countries. Objective: to assess clinical & quality of life benefits in fecal incontinence after TPTNS, in the Hispanic population attended at a referral center from Guadalajara, México. Material and methods: observational, analytic, longitudinal, prospective single-arm study, from 2017 to 2019. Endo-anal ultrasound, anal manometry, Wexner's score and fecal incontinence quality of life (FIQoL) scale were recorded before undergoing TPTNS. Patients underwent TPTNS twice weekly, for 16 weeks. Follow-up assessment included anal manometry performed one month after TPTNS full therapy; Wexner's and FIQoL scales were performed 1, 3 and 6-months after TPTNS therapy. Variables were described in mean or median, according to statistical distribution (Shapiro-Wilk test), and contrasted through follow-up with corresponding hypothesis testing. Analyses were performed using R v3.4.2 (R Foundation for Statistical Computing, Vienna, Austria). Results: 25 patients were included. Mean age was 54.32 ± 13.5 years. 21 (84%) were female. 3 (12%) with diabetes mellitus. 20/21 (95%) women had history of pregnancy with ≥ 1 vaginal delivery, 17/20 (85%) had vaginal tear in more than occasion. Fourteen (56%) patients had prior anorectal surgery that included: five (20%) hemorrhoidectomy, four (16%) fistulotomy and five (20%) others. Seventeen (68%) patients had partial (liquid/gas) fecal incontinence, of these, three (12%) patients complained of urinary incontinence (UI). Total (solid/liquid/gas) fecal incontinence was reported in eight (32%) patients. Internal and external anal sphincter defects were identified by endo-anal ultrasound (100% cases). No complication related to PTNS was shown. After one month of full treatment, anal manometry resting and squeeze pressure increased from 26.6 to 43.0 mmHg and 40.5 to 60.7 mmHg, respectively (p < 0.001). Median Wexner's score was 15 before TPTNS, decreased to 8 after 1-month and 7 after 3-months (p < 0.001). FIQoL scale increased significantly through the follow-up (p < 0.001). 100% reported improvement of UI after six months follow up. Conclusions: due to its significant positive clinical and quality of life benefits related to evacuation rhythm, TPTNS constitutes a valid treatment in the management of fecal incontinence, especially in developing countries.


REFERENCES

  1. Hotouras A, Murphy J, Walsh U, Allison M, Curry A, Williams NS, Knowles C, Chan CL. Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: a prospective cohort study. Ann Surg. 2014; 259 (5): 939-943.

  2. Leroi AM, Siproudhis L, Etienney I, Damon H, Zerbib F, Amarenco G et al. Transcutaneous electrical tibial nerve stimulation in the treatment of fecal incontinence: a randomized trial (Consort 1a). Am J Gastroenterol. 2012; 107 (12): 1888-1896.

  3. Hotouras A, Thaha MA, Boyle DJ, Allison ME, Currie A, Knowles CH et al. Short-term outcome following percutaneous tibial nerve stimulation for faecal incontinence: a single-centre prospective study. Color Dis. 2012; 14 (9): 1101-1105.

  4. Booth J, Hagen S, McClurg D, Norton C, MacInnes C, Collins B, et al. A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care. J Am Med Dir Assoc. 2013; 14 (4): 270-274.

  5. Knowles CH, Horrocks EJ, Bremner SA, Stevens N, Norton C, O'Connell PR, et al. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): A double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet. 2015; 386 (10004): 1640-1648.

  6. Hotouras A, Murphy J, Allison M, Curry A, Williams NS, Knowles CH et al. Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). Surg Today. 2014; 44 (11): 2124-2130.

  7. Govaert B, Pares D, Delgado-Aros S, La Torre F, Van Gemert WG, Baeten CG. A prospective multicentre study to investigate percutaneous tibial nerve stimulation for the treatment of faecal incontinence. Color Dis. 2010; 12 (12): 1236-1241.

  8. López-Delgado A, Arroyo A, Ruiz-Tovar J, Alcaide MJ, Diez M, Moya P, et al. Effect on anal pressure of percutaneous posterior tibial nerve stimulation for faecal incontinence. Color Dis. 2014; 16 (7): 533-537.

  9. Griebling TL. Re: a feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care. Vol. 191, The Journal of urology. American Urological Association Education and Research, Inc.; 2014. p. 422.

  10. Rimmer CJ, Knowles CH, Lamparelli M, Durdey P, Lindsey I, Hunt L, et al. Short-term outcomes of a randomized pilot trial of 2 treatment regimens of transcutaneous tibial nerve stimulation for fecal incontinence. Dis Colon Rectum. 2015; 58 (10): 974-982.

  11. Bouguen G, Ropert A, Lainé F, Pequin P, Morcet J, Bretagne JF et al. Effects of transcutaneous tibial nerve stimulation on anorrectal physiology in fecal incontinence: a double-blind placebo-controlled cross-over evaluation. Neurogastroenterol Motil. 2014; 26 (2): 247-254.

  12. Moyon S, Liang J, Casaccia P. Epigenetics in NG2 glia cells [Internet]. Vol. 1638, Brain Research. 2016. p. 183–98.

  13. Eléouet M, Siproudhis L, Guillou N, Le Couedic J, Bouguen G, Bretagne JF. Chronic posterior tibial nerve transcutaneous electrical nerve stimulation (TENS) to treat fecal incontinence (FI). Int J Colorectal Dis. 2010; 25 (9): 1127-1132.

  14. George AT, Maitra RK, Maxwell-Armstrong C. Posterior tibial nerve stimulation for fecal incontinence: where are we? World J Gastroenterol. 2013; 19 (48): 9139-9145.

  15. Jiménez-Toscano M, Vega D, Fernandez-Cebrián JM, Valle Martín B, Jiménez-Almonacid P, Rueda Orgaz JA. Efficacy and quality of life after transcutaneous posterior tibial neuromodulation for faecal incontinence. Color Dis. 2015; 17 (8): 718-723.

  16. Queralto M, Portier G, Cabarrot PH, Bonnaud G, Chotard JP, Nadrigny M et al. Preliminary results of peripheral transcutaneous neuromodulation in the treatment of idiopathic fecal incontinence. Int J Colorectal Dis. 2006; 21 (7): 670-672.

  17. Wexner SD. Percutaneous tibial nerve stimulation in faecal incontinence. Vol. 386, The Lancet. Elsevier Ltd; 2015. p. 1606.

  18. Wexner SD. Commentary on "home-based percutaneous tibial nerve stimulation for fecal incontinence: Is it feasible?" Vol. 261, Annals of Surgery. 2015. p. 26101.

  19. Al Asari S, Meurette G, Mantoo S, Kubis C, Wyart V, Lehur PA. Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: A comparative case-matched study. Color Dis. 2014; 16 (11): O393-399.

  20. Moya P, Parra P, Arroyo A, Peña E, Benavides J, Calpena R. Sacral nerve stimulation versus percutaneous posterior tibial nerve stimulation in the treatment of severe fecal incontinence in men. Tech Coloproctol. 2016; 20 (5): 317-379.

  21. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal incontinence quality of life scale. Dis Colon Rectum. 2000; 43 (1): 9-16.

  22. Thin NN, Horrocks EJ, Hotouras A, Palit S, Thaha MA, Chan CLH, et al. Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013; 100: 1430-1447.

  23. Biemans JMAE, Van Balken MR. Efficacy and effectiveness of percutaneous tibial nerve stimulation in the treatment of pelvic organ disorders: a systematic review. Neuromodulation. 2013; 16: 25-33.

  24. Grossi U, Hotouras A, Horrocks E, Allison M, Chan CL, Knowles CH. Home-based percutaneous tibial nerve stimulation for fecal incontinence. Ann Surg. 2015; 261 (1): e1.

  25. Thin NN, Taylor SJC, Bremner SA, Emmanuel A V, Hounsome N, Williams NS et al. Randomized clinical trial of sacral versus percutaneous tibial nerve stimulation in patients with faecal incontinence. Br J Surg. 2015; 102 (4): 349-358.

  26. Horrocks EJ, Bremner SA, Stevens N, Norton C, Gilbert D, O'Connell PR et al. Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of faecal incontinence using distal neuromodulation (the CONFIDeNT trial). Health Technol Assess. 2015; 19 (77): 1-164.

  27. Van der Wilt AA, Giuliani G, Kubis C, van Wunnik BPW, Ferreira I, Breukink SO et al. Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence. Br J Surg. 2017; 104 (9): 1167-1176.

  28. Veronique V, Henri D, Sabine R, Francois M. Transcutaneous electrical posterior tibial nerve stimulation for faecal incontinence: effects on symptoms and quality of life. Int J Colorectal Dis. 2010; 25 (8): 1017-1020.

  29. Kelly SL, Radley SC, Brown SR. Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence? Color Dis. 2016; 18 (5): O158-163.

  30. Thomas GP, Dudding TC, Nicholls RJ, Vaizey CJ. Bilateral transcutaneous posterior tibial nerve stimulation for the treatment of fecal incontinence. Dis Colon Rectum. 2013; 56 (9): 1075-1079.

  31. Findlay JM, Yeung JMC, Robinson R, Greaves H, Maxwell-Armstrong C. Peripheral neuromodulation via posterior tibial nerve stimulation - A potential treatment for faecal incontinence? Ann R Coll Surg Engl. 2010; 92 (5): 385-390.

  32. Sucar-Romero S, del Barco LE, Rodríguez-Colorado S, Gorbea-Chávez V. Estimulación del nervio tibial posterior como tratamiento de la disfunción del piso pélvico. Revisión de la bibliografía. Ginecol Obstet Mex. 2014; 82 (8): 535-546.

  33. Arroyo A, Parra P, Lopez A, Peña E, Ruiz-Tovar J, Benavides J et al. Percutaneous posterior tibial nerve stimulation (PPTNS) in faecal incontinence associated with an anal sphincter lesion: results of a prospective study. Int J Surg. 2014; 12 (2): 146-149.

  34. Horrocks EJ, Thin N, Thaha MA, Taylor SJC, Norton C, Knowles CH. Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surgy. 2014; 101: 457-468.




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