Can temporary trans-dermal nerve stimulation VERVTM predict efficacy of permanent sacral nerve implant?
M Mirza, Lamparelli M, Clarke AD,
Faecal incontinence [FI] is a distressing condition that can be difficult to treat. Surgical reconstruction is invasive and even if anatomical correction is achieved good functional results, particularly in the long term, are not guaranteed. Sacral nerve stimulation (SNS) has proved to be a very valuable tool in the treatment of this condition both in terms of its efficacy and its noninvasive technique [1-6]. Patients deemed suitable for SNS are evaluated with a temporary external device which if proved successful allows patients to be considered for a permanent SNS implant. The temporary device requires day case hospital admission and in usually a general anaesthetic to insert. The temporary wire can be painful and risks complications.
The transdermal nerve stimulator VERVTM [Fig 3] offers an attractive alternative to the temporary wire. The adhesive patch can be applied in an outpatient setting by a trained member of staff and has a battery life of a week. It is hypothesized that trans-dermal stimulation may predict the efficacy of SNS and suitability for a permanent implant avoiding a requirement for admission for the temporary device.
Figure 3 VERV stimulator
We studied 8 patients, all females, median age 56 [range 24-77] with faecal and urinary incontinence. All 8 were deemed appropriate to be considered for SNS by a dedicated pelvic floor MDT and were trialed with the temporary SNS device. Following completion of the trial and a ‘wash-out’ period the same group was tested with the VERVTM system. The patches were applied by the same trained individual (SS). Prospective data on outcome was collected throughout the study using faecal (FI) and urinary incontinence (UI) scores.
Pre-treatment FI scores were median 17(range 10-20) and UI scores, median 187(range 80-210). With temporary SNS a significant improvement in 7 out of 8 patients was achieved; FI score median 12(6-20), UI s