Sacral neuromodulation

Sacral nerve stimulation (SNS) is a new minimally invasive treatment available in the armamentarium for the treatment of pelvic floor dysfunctions, particularly fecal incontinence, and involves electrostimulation of the sacral nerves by means of an implantable pulse generator. Despite the fact that the exact mechanisms of action and neural pathways involved are still incompletely known, SNS has gained wide acceptance among colorectal surgeons for its ability to influence several factors responsible for continence, and as a reliable pre-implantation test, with very low surgical risk and a wide range of indications. In fact, fecal incontinence of any etiology (except complete spinal cord injury) and severity has been tested, although with variable success rates. About 15 years since its introduction in coloproctology, studies on the long-term outcome have confirmed its reliability and effectiveness, not only in symptom control but also in improving quality of life. Finally, evaluation of the cost-effectiveness ratio compared with other treatments for fecal incontinence confirms the advantages of SNS, making this technique the first option in the management algorithm of this disabling disease. © 2010 Springer-Verlag Milan.