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Vol. 99. Issue 8.
Pages 585-592 (October 2021)
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Vol. 99. Issue 8.
Pages 585-592 (October 2021)
Original article
Importance of some technical aspects of the procedure of percutaneous posterior tibial nerve stimulation in patients with fecal incontinence
Importancia de algunos aspectos técnicos del procedimiento de estimulación percutánea del nervio tibial posterior en pacientes con incontinencia fecal
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Rodolfo Rodríguez Carrilloa,
Corresponding author
rodolforodriguez8700@gmail.com

Corresponding author.
, María Dolores Ruiz Carmonaa, Rafael Alós Companyb, Andrés Frangi Caregnatoa, Marina Alarcón Iranzoa, Amparo Solana Buenoa, Roberto Lozoya Trujilloa, Eduardo García-Granero Ximénezb
a Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sagunto, Valencia, Spain
b Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Figures (2)
Tables (5)
Table 1. Study selection criteria.
Table 2. Criteria for the etiological classification.
Table 3. Mean levels (±SD) of stimulation and % of motor response in the global series and in the different subgroups.
Table 4. Mean scores (±SD) on the Wexner scale, showing baseline and after the completion of treatment in the global series and by groups.
Table 5. Mean manometry values (±SD), baseline and after the completion of treatment.
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Abstract
Introduction

The results of percutaneous posterior tibial nerve stimulation (PTNS) in the treatment of fecal incontinence (IF) are modest. The aim of the study is to assess the relationship of some technical aspects with the clinical response: location of the nerve, distal response (motor or sensory) and accommodation.

Methods

Prospective study of patients with FI undergoing PTNS therapy. The clinical response was assessed using the Wexner scale, defecation diary and anorectal manometry.

Results

32 patients were studied. The intensity of localization (proximity to the nerve) was not correlated with clinical or manometric changes. Motor response was associated with a decrease on the Wexner scale [12.12 (±5.39) to 7.71 (±4.57) P < .005], the number of episodes of passive incontinence [8.78 (±9.64) to 4.11 (±7.11) P = .025], the total number of incontinence episodes [16.11 (±16.03) to 7.78 (±11.34) P = .009] and the number of days with fecal soiling [6.89 (±5.53) to 2.56 (±4.13) P = .002] and with an increase in the length of the manometric anal canal at rest [4.55 (±0.596) to 4.95 (±0.213) P = .004]. The increase in stimulation (accommodation) was inversely correlated with the decrease in the Wexner scale (r = −0.677 P < .005) and the number of days with soiling (r = −0.650 P = .022).

Conclusions

The motor response during PTNS seems to be related to a better clinical response. The accommodation phenomenon could be associated with worse results. The proximity of the electrode to the nerve does not seem to be important as long as a good distal response is achieved.

Keywords:
Fecal incontinence
Posterior tibial nerve stimulation
Electrostimulation
Resumen
Introducción

Los resultados de la estimulación percutánea del nervio tibial posterior (PTNS) en el tratamiento de la incontinencia fecal (IF) parecen discretos. El objetivo del estudio es valorar la relación de algunos aspectos técnicos con la respuesta clínica: localización del nervio, respuesta distal (motora o sensitiva) y acomodación.

Métodos

Estudio prospectivo de pacientes con IF sometidos a terapia de PTNS. La repuesta clínica se valoró mediante la escala de Wexner, diario defecatorio y manometría anorrectal.

Resultados

Se estudiaron 32 pacientes. La intensidad de localización (cercanía al nervio) no se correlacionó con cambios clínicos ni manométricos. La respuesta motora se relacionó con un descenso en la escala de Wexner [12,12 (±5,39) a 7,71 (±4,57) p < 0,005], el número de episodios de incontinencia pasiva [8,78 (±9,64) a 4,11 (±7,11) p = 0,025], el número total de episodios de incontinencia [16,11 (±16,03) a 7,78 (±11,34) p = 0,009] y el número de días con ensuciamiento fecal [6,89 (±5,53) a 2,56 (±4,13) p = 0,002] y con un aumento de la longitud del conducto anal manométrico en reposo [4,55 (±0,596) a 4,95 (±0,213) p = 0,004]. El incremento de estimulación (acomodación) se correlacionó de forma inversa con la disminución en la escala de Wexner (r = −0,677 p < 0,005) y el número de días con ensuciamiento (r = −0,650 p = 0,022).

Conclusiones

La respuesta motora durante la PTNS parece relacionarse con una mejor respuesta clínica. El fenómeno de acomodación podría asociarse con peores resultados. La cercanía del electrodo al nervio no parece tener trascendencia, siempre que se consiga una buena respuesta distal.

Palabras clave:
Incontinencia fecal
Estimulación del nervio tibial posterior
Electroestimulación

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