Is Percutaneous Tibial Nerve Stimulation Effective and Safety for Treating and Managing Faecal Incontinence (FI) Compared to Sham Electrical Stimulation? A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Abstract Purpose Sacral Nerve Stimulation (SNM) was seen the best second-line treatment for Faecal incontinence (FI). However, expensive, twice operations and complicated procedures blocked the spread of SNM. Percutaneous Tibial Nerve Stimulation (PTNS) were gradually applied to FI with different clinical outcomes, so we conducted a systematic review and meta-analysis of randomized controlled trials to invest the efficacy and safety of PTNS versus sham electrical stimulation for the treatment of FI. Method We searched electric databases including Pubmed, Embase, Web of Science and Cochrane library. All the studies were limited to randomized controlled trails (RCTs) without limitation about region and race. Results Four randomized controlled studies were included in this review, which involved 441 FI adult patients (302 of them received PTNS versus 194 underwent sham electrical stimulation. Our Meta-Analysis showed that PTNS can better reduce the episodes of FI per week compared to control groups (MD=-1.57, 95%CI -2.97 to -0.17, p = 0.03, I2 = 31%). More patients reported more than 50% reductions in FI episodes per week after PTNS (RR = 1.32, 95%CI 1.01 to 1.73, p = 0.04, I2 = 6%). No significant differences existed in any domains of the FI Quality of Life and St Mark’s incontinence scores (MD=-1.44, 95%CI -3.55 to 0.68, p = 0.18, I2 = 81%). No sever events related PTNS had been reported in all participants. Conclusion Compared with sham groups, our Meta-analysis demonstrated that PTNS can better reduced FI episodes, but no differences existed in St Mark’s incontinence scores and FI Quality of Life. In the future, multicentric and well-designed trials with longer follow-up periods will be conducted to confirm our conclusions.