Abstract
Background
Anal acoustic reflectometry (AAR), a novel test of anal sphincter function, was shown to predict a successful trial phase of sacral neuromodulation (SNM) for faecal incontinence. This follow-up study aims to explore if AAR can also predict short- and long-term SNM outcomes at less than and more than five years respectively.
Method
Outcome data was reviewed from a prospectively managed database. Successful treatment was defined as >50% improvement in patient reported faecal incontinence or urgency episodes, or in a symptom severity score.
Results
Twenty-six female patients (median: 53 years [range 31–80]) who received a permanent SNM implant were analysed. In the short-term, no differences were observed in baseline AAR and symptom severity parameters between patients reporting success or failure. At long-term follow-up (median: 122 months [113-138]) data was available from 17 (17/26, 65%) patients with 7 (7/17, 41%) reporting continued treatment success. Baseline faecal urgency episodes (p = 0.003), and the AAR parameters of opening elastance (p = 0.043) and squeeze opening elastance (p = 0.025) were significantly different between patients reporting success and those reporting failure. Squeeze opening elastance demonstrated the greatest ability to discriminate between success and failure (area under the curve: 0.82 (95% C.I. 0.60 – 1.01, p = 0.003).
Conclusion
AAR may have a role in identifying patients suitable for SNM treatment with clinically relevant metrics associated with successful response to treatment. Future work should explore this further to improve SNM patient selection
Anal acoustic reflectometry (AAR), a novel test of anal sphincter function, was shown to predict a successful trial phase of sacral neuromodulation (SNM) for faecal incontinence. This follow-up study aims to explore if AAR can also predict short- and long-term SNM outcomes at less than and more than five years respectively.
Method
Outcome data was reviewed from a prospectively managed database. Successful treatment was defined as >50% improvement in patient reported faecal incontinence or urgency episodes, or in a symptom severity score.
Results
Twenty-six female patients (median: 53 years [range 31–80]) who received a permanent SNM implant were analysed. In the short-term, no differences were observed in baseline AAR and symptom severity parameters between patients reporting success or failure. At long-term follow-up (median: 122 months [113-138]) data was available from 17 (17/26, 65%) patients with 7 (7/17, 41%) reporting continued treatment success. Baseline faecal urgency episodes (p = 0.003), and the AAR parameters of opening elastance (p = 0.043) and squeeze opening elastance (p = 0.025) were significantly different between patients reporting success and those reporting failure. Squeeze opening elastance demonstrated the greatest ability to discriminate between success and failure (area under the curve: 0.82 (95% C.I. 0.60 – 1.01, p = 0.003).
Conclusion
AAR may have a role in identifying patients suitable for SNM treatment with clinically relevant metrics associated with successful response to treatment. Future work should explore this further to improve SNM patient selection
| Original language | English |
|---|---|
| Pages (from-to) | 183-189 |
| Journal | Journal of Surgical Research |
| Volume | 305 |
| Early online date | 18 Dec 2024 |
| DOIs | |
| Publication status | Published - 1 Jan 2025 |
Keywords
- Sacral Neuromodulation
- Faecal Incontinence
- Elastance
- Anal Sphincter
- Anorectal Physiology