Comparison of percutaneous tibial nerve stimulation and bulking agent injection (polyacrylonitrile) in treating fecal incontinence

Abstract

Aim: Fecal incontinence is still continuing to be a complex disorder for colorectal surgeon’s practice. Nerve stimulation and bulking agent injection are two different minimal invasive methods for its treatment. Our aim was to compare the short-term effectiveness of percutaneous tibial nerve stimulation (PTNS) and bulking agent injection in treating fecal incontinence. Method: A total of 41fecal incontinance patients, who were treated with PTNS or bulking agent (polyacrylnitrile) injection (PI) at the Istanbul Faculty of Medicine, were enrolled. Demographic data, the etiology of fecal incontinence, anal physiological test results, Wexner Fecal Incontinence Score and Modified Fecal Incontinence Quality of Life-Scale score were evaluated. These questionnaires were performed before and 12 months after the end of treatment. Results: Twenty-four patients (59%) were female, and 17 of them (41%) were male. The median age was 50 years (25-71), and the mean body mass index was 27.7 kg/m2 (20-41). Twenty-two (54%) patients underwent PTNS whereas 19 (46%) patients underwent PI. Both groups were found similar in terms of demographic data and pre-treatment measures for fecal incontinence. When the fecal incontinence and quality of life score of the patients were evaluated before and after the procedure, both methods were found efficient in fecal incontinence treatment (p<0.001). It has been experienced that these two techniques were equally effective when they were compared to each other (p=0.315 and 0.501). Conclusion: Both tecniques were effective in treating fecal incontinence. The percutaneous tibial nerve stimulation is less invasive, whereas polyacrylnitrile implantation requires fewer hospital visits with faster improvement.

Keywords

• Fecal incontinence
• nerve stimulation
• bulking-agent injection