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Sponsored by: |
University of Lausanne Hospitals |
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Information provided by: | University of Lausanne Hospitals |
ClinicalTrials.gov Identifier: | NCT00522691 |
Sacral nerve stimulation (SNS) is an emerging treatment for patients with severe faecal incontinence. The test stimulation is minimally invasive, associated to low morbidity and relatively cheap. On the contrary, implantation of the definite stimulator is related to higher morbidity and considerable costs. A careful patent selection for definite implantation is therefore crucial. However, indication for implantation is actually based only on the subjective criteria reported in the patients´ diary only. Patients and care providers are likely to overestimate the real effect of SNS leading to an unjustified overuse of this expensive device. It is therefore necessary to evaluate real efficacy of SNS during the testing phase in a unbiased setting in order to avoid unnecessary morbidity and costs.
Condition | Intervention |
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Fecal Incontinence |
Procedure: sacral nerve stimulation |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double Blind (Subject, Investigator, Outcomes Assessor), Placebo Control, Crossover Assignment, Efficacy Study |
Official Title: | Efficacy of Sacral Nerve Stimulation Before Definitive Implantation: a Multicenter Randomized, Double Blind, Crossover Trial |
Estimated Enrollment: | 34 |
Study Start Date: | September 2007 |
Arms | Assigned Interventions |
---|---|
A: Experimental
Phase 1: sacral nerve stimulation crossover Phase 2 : sham stimulation
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Procedure: sacral nerve stimulation |
B: Experimental
Phase 1: sham stimulation crossover Phase 2: sacral nerve stimulation
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Procedure: sacral nerve stimulation |
Sacral nerve stimulation (SNS) is an emerging treatment for patients with severe faecal incontinence when conservative measures fail and surgical repair is not indicated. In a minimally-invasive approach and under local anaesthesia, an electrode is placed around sacral nerve root S2-4 and electrical stimulation is applied to the sacral spinal nerves. Effectiveness of SNS is definitively not only explained by placebo effect but the pathophysiologic mechanisms remain unclear. Suggested pathways include modulation of afferent nerve fibres and direct stimulation of the pelvic floor and anal sphincter muscle. After placement of the electrode, the patient is stimulated by an external stimulator for 1-3 weeks. During this period, the patient documents the number of faecal incontinence episodes or urgencies in a symptom diary. By convention, indication for permanent stimulation is based on a 50% reduction in the number of episodes. After a successful testing period, the permanent stimulator is implanted, generally in the upper gluteal region.
Previous studies report success rates up to 80%. The only randomized trial with a proper sample size evaluated the efficacy of SNS after definite implantation. In this study, 63% of the patients felt improved during the placebo period and might not really benefit from the device. The real success rate of SNS is therefore likely to be considerably lower. Efficacy of SNS during the testing phase has never been assessed in a blinded randomized study.
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion criteria:
Contact: Martin Hubner, MD | +41213142418 | martin.hubner@chuv.ch |
Contact: Yannick Cerantola, MD | +41213142383 | yannick.cerantola@chuv.ch |
Switzerland, Vaud | |
Visceral surgery, university hospital | |
Lausanne, Vaud, Switzerland, 1005 |
Principal Investigator: | Martin Hubner, MD | Visceral Surgery, University Lausanne, Switzerland |
Study Director: | Jean-Claude Givel, Professor | Visceral Surgery, University Lausanne, Switzerland |
Study Chair: | Nicolas Demartines, Professor | Visceral Surgery, University Lausanne, Switzerland |
Study ID Numbers: | CHV120/07 |
Study First Received: | August 28, 2007 |
Last Updated: | August 28, 2007 |
ClinicalTrials.gov Identifier: | NCT00522691 |
Health Authority: | Switzerland: Ethikkommission |
Fecal incontinence, sacral nerve stimulation |
Signs and Symptoms Fecal Incontinence Digestive System Diseases Urologic Diseases Urination Disorders |
Gastrointestinal Diseases Urinary Incontinence Intestinal Diseases Rectal Diseases |
Urological Manifestations |