SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Henri DAMON
Coup de coeur :
 
 
Colorectal Disease
  2017/05  
 
  2017 May;19(5):O134-O144  
  doi: 10.1111/codi.13632.  
 
  Sacral neuromodulation compared with injection of bulking agents for faecal incontinence following obstetric anal sphincter injury - a randomized controlled trial.  
 
  Rydningen M, Dehli T, Wilsgaard T, Rydning A, Kumle M, Lindsetmo RO, Norderval S  
  https://www.ncbi.nlm.nih.gov/pubmed/28211186  
 
 

Abstract

AIM:

The purpose of this trial was to compare the effectiveness of sacral neuromodulation (SNM) with a submucosal injection of collagen (Permacol®) in women with faecal incontinence following obstetric anal sphincter injury (OASIS).

METHOD:

This single-blinded randomized controlled trial at two hospital units in Norway included women with faecal incontinence following OASIS. Eligible women who had had a successful percutaneous nerve evaluation were randomly assigned to SNM or Permacol®. The primary outcome was the difference in the St Mark's incontinence score between baseline and 6 months. Secondary outcomes were changes in the disease-specific quality of life (FIQL) and urinary incontinence (ICIQ-UI-SF) scores.

RESULTS:

Fifty-eight women were randomly assigned to SNM (n = 30) and Permacol® (n = 28). The reduction in the St Mark's score between baseline and 6 months was 11.2 (SD 5.3) in the SNM group vs 2.3 (SD 5.0) in the Permacol® group, resulting in a difference of 8.9 (95% CI: 6.1-11.7, P < 0.0001). The differences in the four scales of FIQL (lifestyle, coping, depression, embarrassment) were 0.90 (95% CI: 0.50-1.30, P < 0.001), 1.05 (0.62-1.47, P < 0.001), 0.52 (95% CI: 0.16-0.87, P = 0.005) and 0.95 (95% CI: 0.50-1.40, P < 0.001), respectively, in favour of SNM. The difference in the ICIQ-UI-SF was 5.0 (95% CI: 1.97-8.02, P = 0.002) in favour of SNM. There were nine minor adverse events in the SNM group compared with seven in the Permacol® group (P = 0.77).

CONCLUSION:

SNM was superior to Permacol® in terms of reduction of St Mark's score, ICIQ-UI-SF and the change of the FIQL in women with faecal incontinence following OASIS.

 

 
Question posée
 
Le but de cette étude était de comparer l'efficacité de la neuromodulation des racines sacrées (SNM) avec les injections sous-muqueuse de collagène (Permacol®) chez les femmes souffrant d'une incontinence fécale après atteinte post-obstétricale du sphincter anal (OASIS).
 
Question posée
 
A 6 mois, la NMS était supérieure sur l’amélioration des symptômes et de la qualité de vie.
 
Commentaires

Les résultats de cette étude randomisée confirment l’efficacité de la NMS dans le cadre de l’incontinence fécale d’origine obstétricale. La supériorité de la NMS aux injections de collagène était très probable, néanmoins les études randomisées dans ce domaine sont particulièrement rares.

 
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