Papoutsi S, Ringger A, Cecini-Hertig R, Inderbitzin D
Percutaneous tibial nerve stimulation (PTNS) is a minimal in-vasive treatment and can be performed in the outpatient clinic. The aim of our study was to assess the efficacy PTNS in fecal incontinence (FI) and to evaluate the possibility of implementing a standardized treatment protocol.
Methods: A prospective cohort of patients with FI was treated with PTNS therapy (Figure1) during at least 16 weeks (12 x weekly, followed by twice a month and 2x every 3 weeks). Incontinence was evaluated using the Wexner Fecal Incontinence Score (WFIS)  before treatment and after 3, 5 and 7 months of therapy. The Rockwood Fecal Incontinence Quality of Life questi-onnaire (FIQLS)  was assessed before and after treatment.
Results: A total of 26 patients (n=26) were treated between December 2013 and March 2015. The mean age was 60±19.3 years (mean±SD) and 16 of them (61.5 %) were female. Follow up ranged from 5 to 14 months. Statistical analysis showed significant improvement of the WFIS from pre-treatment to 3, 5, 7 months into the therapy (p<0.05) (Figure 2) with a median pre-treat-ment score of 14 (CI 95: 11.07-14.93) to a post-treatment score of 4 (CI 95: 2.97-7.65) (Figure 3).
The subgroup of the 40 ≤ years old showed a higher mean of difference with a value of -9.5 WFIS (CI: -14.63 to -4.37) compared to the subgroup of the >40 years old with a value of -7.15 WFIS (CI: -9.52 to -4.78) (Figure 4). The improvement in both subgroups was statistically significant (p=0.0051 resp. p<0.0001). There were five non-responders (19%) to the PTNS therapy and two of them had a sphincter lesion.
The FIQLS pre-treatment to post-treatment for every single subcomponent (AQOL lifestyle, coping, depression and embarrassment) showed significant improvement (p=0.0001) (Figure 5).
PTNS is a well-tolerated treatment for FI. At the moment there is no standardized protocol in use. Taking this into consideration our results show the present treatment protocol to be effective.
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2. Todd H. Rockwood, James M. Church et al. Fecal Incontinence Quality of Life Scale. Quality of Life Instrument for Patients with Fecal In-continence. Diseases Colon Rectum,