Purpose: Sacral nerve modulation (SNM) for fecal incontinence (FI) is not yet approved by the FDA . The aim of this study is to evaluate the efficacy of SNM in treatment of fecal incontinence with voiding dysfunction (VD) in female patients.
Methods: Twenty four female patients with FI and VD underwent two stage SNM implantation after successful peripheral nerve stimulation between October 2003 -2007 by the Urologists. Patients demographics and morbidity were reviewed.The patients were evaluated by preoperative and postoperative questionnaires which included Wexner incontinence scores, Fecal Incontinence Quality of Life Scale (FIQL) and Bristol stool scale.This was done via review of their medical records and telephone interviews.
Results: Twenty four female patients underwent successful implantation of the stimulator.16 patients could be contacted. The median follow up was 28 months (range 3-49 months). Seven (43.8%) experienced no symptom improvement after SNM, five (31%) patients had the stimulator removed; three (19%) because of poor clinical response and two due to infection at the site of the stimulator. Two (12%) received a colostomy for symptom control although the stimulator remains in place for urinary symptoms. Nine (56%) patients in whom SNM is currently functioning show significant improvement in their symptoms. Incontinence scores (Wexner 0-20,) was reduced from mean 15+/-2.8 before sacral nerve stimulation to mean 10+/-7.2 (P= 0.006). FIQL scores improved significantly with improvement in all areas: life style from 1.9 to 2.5 (p=0.01), coping-behavior from 1.8 to 2.3 (P=0.03), depression and self-perception from 2.5 to 3.2 (P=0.003), and embarrassment from 2.39 to 3.03(P=0.03). This was also accompanied by a change stool form on the Bristol scale.
Conclusions: SNM in patients with FI and VD helps control of symptoms and improves quality of life. The lack of FDA approval limits the use of SNM for FI as an exclusive diagnosis.
showing preoperative and postoperative scores

Parameter		Pre-Sacral Nerve Stimulation	Post- Sacral Nerve Stimulation	p value
Wexner Score for FI Mean +/- SD		15.6 +/- 2.8	10.13 +/- 7.12	0.006
Fecal Incontinence Quality Of Life Scale(FIQL)Mean values	Life style	1.91	2.55	0.01
	Coping	1.18	2.30	0.03
	Depression	2.52	3.23	0.003
	Embarrassment	2.39	3.03	0.03

Wexner Score = 0-20 . 0 =Total continence