Purpose: Multiple techniques have been utilised in the management of faecal incontinence that can affect approximately 18% of the adult population. Methods used range from conservative measures such as biofeedback to surgical procedures such as sacral nerve stimulation. Whilst SNS has been shown to be a safe and effective therapy it does have high associated costs with long term results showing a reduction in efficacy with time. PTNS is an emerging alternative that has evolved from the managemetn of urinary incontinence, involving stimulation of the tibial nerve at multiple sittings. This study aimed to assess the functional outcome of patients treated in our institution with PTNS pre-treatment, post treatment and at one year.
Method: Patients undergoing neuromodulation with PTNS in our institution were included in this study. A treatment regime of 30 minutes with PTNS for 12 weeks was undertaken. All patients were assessed pre, post treatment and at 1 year with validated questionnaires. Questionnaires used were the CCFIS and FIQOL scores. Data was analysed with SPSS using the Wilcoxon signed rank test with significance at p<0.05.
Results: Forty patients underwent PTNS treatment in this study, 36 were female with mean age of 60 years (range 34-85). 30 patients (75%) were successful with a trial of PTNS with 9 (23%) failing the trial and one being lost to follow up. Of the successful trial patients a further 4 were lost to follow up at one year. Comparison of the individual components of the FIQOL scores demonstrated significant improvement (p<0.05) in lifestyle, coping, depression and embarrassment scores post treatment (n=38) and in coping, depression and embarrassment scores at 1 year (n=9) with only lifestyle showing a lack of significance. CCFIS scores were significantly improved in the post treatment group with z-3.75, p<0.05 r=-0.43 and at 1 year, z=-0.26, p<0.05, r=-63.
Conclusions: PTNS has shown a statistically significant benefit in CCFIS scores and FIQOL scores post treatment and at 1 year. The number of patients at 1 year is small however this treatment is in its infancy and further long term studies will be needed to confirm benefit over time.