Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence

B R Hornung; G L Carlson; P J Mitchell; N Klarskov; G Lose; K J Telford; E S Kiff

doi:10.1002/bjs.9586

Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence

B R Hornung, G L Carlson, P J Mitchell, N Klarskov, G Lose, K J Telford, E S Kiff

Department of Clinical Medicine

7 Citations (Scopus)

Abstract

Background Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence. Methods Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE. The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success. Results Fifty-two patients were recruited, of whom 32 (62 per cent) had a successful PNE outcome and 20 (38 per cent) an unsuccessful outcome. The AAR variable opening pressure was significantly greater in patients who subsequently had a successful PNE result compared with the pressure in patients who did not (28 versus 17 cmH₂O; P = 0·008). No difference was seen in the manometric equivalent, maximum resting pressure. Opening pressure was an independent predictor of success with an odds ratio of 1·08 (95 per cent confidence interval 1·01 to 1·16; P = 0·018). Conclusion AAR is a sensitive test of sphincter function and can identify differences between patients who respond to PNE and those who do not. Opening pressure is an independent predictor of success in PNE, and may be of value in the selection of patients for this expensive treatment option. Opening pressure predicts percutaneous nerve evaluation success

Original language	English
Journal	British Journal of Surgery
Volume	101
Issue number	10
Pages (from-to)	1310–1316
Number of pages	7
ISSN	0007-1323
DOIs	https://doi.org/10.1002/bjs.9586
Publication status	Published - Sept 2014

Keywords

Acoustics
Adult
Aged
Anal Canal
Electric Stimulation Therapy
Fecal Incontinence
Female
Humans
Lumbosacral Plexus
Manometry
Middle Aged
Pressure
ROC Curve
Regression Analysis
Treatment Outcome

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https://academic.oup.com/bjs/article-pdf/101/10/1310/36619408/bjs9586.pdf

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@article{b60d9bdc9aa147568a957cdce946610e,

title = "Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence",

abstract = "Background Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence. Methods Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE. The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success. Results Fifty-two patients were recruited, of whom 32 (62 per cent) had a successful PNE outcome and 20 (38 per cent) an unsuccessful outcome. The AAR variable opening pressure was significantly greater in patients who subsequently had a successful PNE result compared with the pressure in patients who did not (28 versus 17 cmH2O; P = 0·008). No difference was seen in the manometric equivalent, maximum resting pressure. Opening pressure was an independent predictor of success with an odds ratio of 1·08 (95 per cent confidence interval 1·01 to 1·16; P = 0·018). Conclusion AAR is a sensitive test of sphincter function and can identify differences between patients who respond to PNE and those who do not. Opening pressure is an independent predictor of success in PNE, and may be of value in the selection of patients for this expensive treatment option. Opening pressure predicts percutaneous nerve evaluation success",

keywords = "Acoustics, Adult, Aged, Anal Canal, Electric Stimulation Therapy, Fecal Incontinence, Female, Humans, Lumbosacral Plexus, Manometry, Middle Aged, Pressure, ROC Curve, Regression Analysis, Treatment Outcome",

author = "Hornung, {B R} and Carlson, {G L} and Mitchell, {P J} and N Klarskov and G Lose and Telford, {K J} and Kiff, {E S}",

note = "{\textcopyright} 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.",

year = "2014",

month = sep,

doi = "10.1002/bjs.9586",

language = "English",

volume = "101",

pages = "1310–1316",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "JohnWiley & Sons Ltd",

number = "10",

}

TY - JOUR

T1 - Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence

AU - Hornung, B R

AU - Carlson, G L

AU - Mitchell, P J

AU - Klarskov, N

AU - Lose, G

AU - Telford, K J

AU - Kiff, E S

PY - 2014/9

Y1 - 2014/9

N2 - Background Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence. Methods Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE. The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success. Results Fifty-two patients were recruited, of whom 32 (62 per cent) had a successful PNE outcome and 20 (38 per cent) an unsuccessful outcome. The AAR variable opening pressure was significantly greater in patients who subsequently had a successful PNE result compared with the pressure in patients who did not (28 versus 17 cmH2O; P = 0·008). No difference was seen in the manometric equivalent, maximum resting pressure. Opening pressure was an independent predictor of success with an odds ratio of 1·08 (95 per cent confidence interval 1·01 to 1·16; P = 0·018). Conclusion AAR is a sensitive test of sphincter function and can identify differences between patients who respond to PNE and those who do not. Opening pressure is an independent predictor of success in PNE, and may be of value in the selection of patients for this expensive treatment option. Opening pressure predicts percutaneous nerve evaluation success

AB - Background Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence. Methods Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE. The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success. Results Fifty-two patients were recruited, of whom 32 (62 per cent) had a successful PNE outcome and 20 (38 per cent) an unsuccessful outcome. The AAR variable opening pressure was significantly greater in patients who subsequently had a successful PNE result compared with the pressure in patients who did not (28 versus 17 cmH2O; P = 0·008). No difference was seen in the manometric equivalent, maximum resting pressure. Opening pressure was an independent predictor of success with an odds ratio of 1·08 (95 per cent confidence interval 1·01 to 1·16; P = 0·018). Conclusion AAR is a sensitive test of sphincter function and can identify differences between patients who respond to PNE and those who do not. Opening pressure is an independent predictor of success in PNE, and may be of value in the selection of patients for this expensive treatment option. Opening pressure predicts percutaneous nerve evaluation success

KW - Acoustics

KW - Adult

KW - Aged

KW - Anal Canal

KW - Electric Stimulation Therapy

KW - Fecal Incontinence

KW - Female

KW - Humans

KW - Lumbosacral Plexus

KW - Manometry

KW - Middle Aged

KW - Pressure

KW - ROC Curve

KW - Regression Analysis

KW - Treatment Outcome

U2 - 10.1002/bjs.9586

DO - 10.1002/bjs.9586

M3 - Journal article

C2 - 25043271

SN - 0007-1323

VL - 101

SP - 1310

EP - 1316

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 10

ER -

Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence

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