Treatment of radiotherapy and related morbidity Temporary sacral nerve stimulation for faecal incontinence following pelvic radiotherapy Yasuko Maeda a,b,c, * , Morten Høyer b , Lilli Lundby a , Steen Buntzen a , Søren Laurberg a a Surgical Research Unit, Aarhus University Hospital, Denmark; b Department of Oncology, Aarhus University Hospital, Denmark; c Physiology Unit, St. Mark’s Hospital, Harrow, UK article info Article history: Received 4 February 2010 Received in revised form 9 April 2010 Accepted 29 April 2010 Available online 1 June 2010 Keywords: Sacral nerve stimulation Faecal incontinence Pelvic radiotherapy Cancer abstract Temporary sacral nerve stimulation for faecal incontinence caused by pelvic radiation injuries was suc- cessful in 7 of 13 patients (54%). The improvement of total incontinence episodes during the temporary stimulation period was a median of 83% (range 25–93%). This may be a viable treatment option for radi- ation-induced faecal incontinence. Ó 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 97 (2010) 108–112 Radiotherapy plays a major role in treating pelvic cancer. The technique of administering radiation has evolved and improved, particularly in the last 15 years, which has contributed to reduc- tion of adverse effects whilst preserving therapeutic effect. Inten- sity-modulated and image-guided radiotherapy are now the standard techniques that allow precise and conformal delivery of the radiation to the target whilst minimizing the dose to the nor- mal tissues [1,11]. However, some normal tissues surrounding a tumour still receive inadvertent radiation which may result in irre- versible and chronic complications. Faecal incontinence is a late onset complication of pelvic radio- therapy which is said to occur in up to 50% of patients [20,25]. It significantly impairs patients’ quality of life and potentially a life-time burden to the patients [7,14]. Currently, there is a huge gap in the available treatment options as conservative treatment is not an ideal as a long-term solution and major surgery is limited to those with severe symptoms. Sacral nerve stimulation is a minimally invasive procedure which has become an established option of treatment for faecal incontinence in Europe over the last decade. It has been reported to improve incontinence symptoms in some patients following sur- gical oncological operations with or without adjuvant chemoradi- ation albeit in small case reports (Table 1). We report our results of temporary sacral nerve stimulation for patients with faecal incontinence following pelvic radiotherapy. Methods Data of patients who underwent sacral nerve stimulation for faecal incontinence following pelvic radiotherapy at our institution over 7 years (between March 2002 and August 2009) were re- viewed. The patients were offered a temporary sacral nerve stimu- lation when they failed conservative management such as using protective measures (pad, anal plug), anti-diarrhoeal medication, biofeedback (anal sphincter training with a feedback instrument) or retrograde irrigation (to ensure complete emptying of the rec- tum and descending colon to avoid stool leakage). Patients’ incontinence symptoms were evaluated by a bowel diary [16] and Wexner’s incontinence score [13]. The patients were asked to fill in a bowel diary over a 3-week period prior to and dur- ing the PNE. The bowel diary used was the standard SNS bowel diary used in a previous study [16] which includes daily documen- tation of the number of urge and passive incontinence episodes. Radiotherapy data were reviewed retrospectively from medical notes and therapy records. Sacral nerve stimulation The procedure is a two-staged operation. The first stage is a test operation called percutaneous nerve evaluation (PNE). A tempo- rary electrode is inserted into a sacral foramen and the electrode is attached to an external stimulator. The stimulation of sacral nerve root will be carried out over 3-week period during which the patients fill in a bowel diary documenting their incontinence symptoms. After the test period, if the symptoms improve, the 0167-8140/$ - see front matter Ó 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.radonc.2010.04.023 * Corresponding author at: Surgical Research Unit, Aarhus University Hospital, Aarhus, Denmark. E-mail address: yazmaeda@googlemail.com (Y. Maeda). Radiotherapy and Oncology 97 (2010) 108–112 Contents lists available at ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.com