gms | German Medical Science

Background: Since there are very limited data on patients with spina bifida treated by sacral neuromodulation, we report a case of a 22 year old women with combined fecal (grade III) and urinary overflow incontinence based on a follow-up of 28 months.

Materials and methods: Peripheral nerve evaluation (PNE) was performed as a diagnostic approach, since all conservative therapies to treat the fecal incontinence have been exhausted. Computed tomography images were recorded beforehand in order to ensure access to the sacral nerves. After a test period of 3 weeks bowel and urinary conditions improved more than 50%, so that in a second step the permanent electrode and the neurostimulator were implanted under local anesthesia.

Results: Wexner Score decreased from 17 at baseline to 6, 5 and 4, fecal incontinence episodes per week from 20 to 1,1, and 0, urinary urge episodes from 40 to 5, 3,2 and number of self-catheterizations from 8 to 0,0 and 0 after a follow-up of 6m, 12m and 28 months respectively.

Conclusion: Sacral neuromodulation is an effective and safe treatment modality for complex combined bowel and urinary disorders subject to spina bifida. Local anesthesia should be preferred, because motor response might be missing.

Table 1 [Tab. 1], Figure 1 [Fig. 1]