***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE : Fecal incontinence is a psychologically devastating and socially incapacitating condition . Conventional treatment is likely to improve continence in many patients ; however , there remains a group with persisting symptoms who are not amenable for a simple surgical repair . We evaluated the effect of sacral neuromodulation in patients with structurally intact sphincters after failure of conventional treatment . METHODS : Patients aged 18 to 75 years were evaluated . Incontinence was defined as involuntary loss of stool at least once per week , which was objectified by completion of a three-week bowel-habits diary during ambulatory electrode stimulation at the S3 or S4 foramen . Patients were qualified for permanent stimulation when showing a reduction of at least 50 percent in incontinence episodes or days . RESULTS : Seventy-five patients ( 66 females ; mean age , 52 ( range , 26–75 ) years ) were treated . Three patients had partial spinal cord injury , two patients a previous low-anterior resection , and nine patients had a previous sphincter repair . Evaluation after trial screening showed that 62 patients ( 83 percent ) had improved continence . Median incontinence episodes per week decreased from 7.5 to 0.67 ( P < 0.01 ) , median incontinence days per week from 4 to 0.5 ( P < 0.01 ) . The symptomatic response stayed unchanged after implantation of a permanent electrode and pacemaker in 50 patients . After a median follow-up of 12 months , this effect could be sustained in 48 patients . Anal manometry during stimulation showed no increase of sphincter pressures . CONCLUSIONS : Sacral neuromodulation is a feasible treatment option for fecal incontinence in patients with structurally intact sphincters Aim Sacral nerve stimulation ( SNS ) has a place in the treatment algorithm for faecal incontinence ( FI ) . However , after implantation , 15–30 % of patients with FI fail to respond for unknown reasons . We investigated the effect of SNS on continence and quality of life ( QOL ) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI Purpose Sacral nerve stimulation ( SNS ) can improve  fecal incontinence  , though the exact mechanism is not known . This study examines the following hypotheses : SNS leads to contraction of the pelvic floor , influences rectal perception , and improves continence and quality of life . Methods Fourteen patients with sacral nerve stimulators implanted for fecal incontinence were examined prospect ively .  Morphological and functional assessment was done by  endosonography , manometry , and  volumetry  with the stimulator turned on and off in direct succession . Question naires were used to determine incontinence and quality of life . Results With the stimulator turned on , rectal filling conditions were perceived only at higher volumes ; in particular , the defecation urge was sensed only at higher volumes . There was also a reduction in the diameters of the external and internal anal sphincters and a decrease in the distance between the anal mucosa and the symphysis as a sign of pelvic floor elevation . Six months after surgery , continence and quality of life were markedly better than before the operation . Conclusions We were able to confirm the hypotheses given above . The improvements of pelvic floor contraction and rectal perception are rapid adjustment processes in response to stimulation of sacral nerves S3/S4 when turning on the stimulator BACKGROUND : Numerous studies advocate the short-term benefits of sacral nerve stimulation for fecal incontinence , but there has been a paucity of studies on longer-term outcomes . OBJECTIVE : The objective of this study was to report the long-term outcome of sacral nerve stimulation performed for fecal incontinence at a single institution . PATIENTS AND DESIGN : Between January 2004 and May 2007 , 53 patients underwent definitive sacral nerve stimulation for fecal incontinence at our institution . Prospect ively recorded baseline information , including Wexner incontinence scores and st and ard short-form ( SF-12 ) health survey scores , were compared with scores at follow-up . RESULTS : Forty-one patients were available for long-term follow-up with a mean duration of 51 months . The median Wexner score decreased from a baseline of 11.5 ( range , 3.0–18.0 ) to 8.0 ( range , 0.0–18.0 ) at follow-up . The mean difference in Wexner score was 2.7 ( P < .001 ) . There was no statistically significant change in SF-12 physical scores , but a small but highly significant change occurred in SF-12 mental scores . The median SF-12 mental domain score was 49.5 ( range , 15.0–62.1 ) at baseline , and 57.0 ( range , 20.0–64.0 ) at follow-up , with a mean difference of 4.5 ( P = .006 ) . Subgroup analysis performed comparing patients with or without prior intersphincteric silicon bio material implants demonstrated a mean difference in Wexner score of −3.5 ( no implant ) vs 0.0 ( previous implant ) , with P < .09 ( not statistically significant ) . CONCLUSIONS : Sacral nerve stimulation results in a statistically significant improvement in fecal incontinence scores in the long term BACKGROUND In patients with faecal incontinence in whom conservative treatment fails , options are limited for those with a functionally deficient but morphologically intact sphincter . We investigated the effect of sacral nerve stimulation on continence and quality of life . METHODS In this multicentre prospect i ve trial , 37 patients underwent a test stimulation period , followed by implantation of a neurostimulator for chronic stimulation in 34 .  Effect on continence was assessed by daily bowel-habit diaries over a 3-week period and on quality of life by the disease-specific American Society of Colon and Rectal Surgeons ( ASCRS ) question naire and the st and ard short form health survey question naire ( SF-36 ) . Every patient served as his or her own control . FINDINGS Frequency of incontinent episodes per week fell ( mean 16.4 vs 3.1 and 2.0 at 12 and 24 months ; p<0.0001 ) for both urge and passive incontinence during median follow-up of 23.9 months . Mean number of days per week with incontinent episodes also declined ( 4.5 vs 1.4 and 1.2 at 12 and 24 months , p<0.0001 ) , as did staining ( 5.6 vs 2.4 at 12 months ; p<0.0001 ) and pad use ( 5.9 vs 3.7 at 12 months ; p<0.0001 ) . Ability to postpone defecation was enhanced ( at 12 months , p<0.0001 ) , and ability to completely empty the bowel was slightly raised during follow-up ( at 12 months , p=0.4122 ) . Quality of life improved in all four ASCRS scales ( p<0.0001 ) and in seven of eight SF-36 scales , though only social functioning was significantly improved ( p=0.0002 ) . INTERPRETATION Sacral nerve stimulation greatly improves continence and quality of life in selected patients with morphologically intact or repaired sphincter complex offering a treatment for patients in whom treatment options are limited INTRODUCTION Faecal incontinence ( FI ) is a highly prevalent disorder that severely affects the health related quality of life ( HRQOL ) of the patients who suffer from it . Neuromodulation is a minimally invasive treatment that has demonstrated its efficacy in the treatment of FI symptoms over the past 10 years . The aim of this study is to check whether there is an improvement in the quality of life , using EuroQuol ( EQ-5D ) , in patients with faecal incontinence treated with sacral root neuromodulation . METHODOLOGY An observational study with prospect i ve recording of quality of life data , before and after , using the EQ-5D on a series of patients diagnosed with moderate to severe FI with a complete or repaired sphincter who had a definitive MEDTRONIC Interstim ( ® ) 3023 implant after a subchronic stimulation phase with a good response . RESULTS The initial mean number of leaks was 3.1±1 , and the final was 0.5±0.6 . The mean number of escapes per week decreased to 2.6 escapes ( CI 95 % : 2.1 - 3.1 ) after the definitive implant of the sacral root stimulator ( P<.001 ) . The mean baseline health status score was 55.9±13 , and after neuromodulation it was 63.1±13 . Thus , the visual analogue scale score increased by 7.1 points ( CI 95 % : 0.37 - 14 ) after the definitive implant of the sacral root stimulator ( P<.05 ) . In the HRQOL variables studied with the EQ-5D question naire , we found an improvement with neuromodulation in the mobility and the presence of anxiety and /or depression variables . On the other h and we found an improvement with the neurostimulator implant , which was not significant , in personal care , performing daily activities and the presence of pain and /or discomfort . The current health was better in 11 patients ( 57.9 % ) , the same in 7 ( 36.8 % ) and worse in 1 ( 5.3 % ) . CONCLUSIONS Neuromodulation is a therapy that has demonstrated a significant improvement in HRQOL measured with the EQ-5D BACKGROUND : Sacral nerve stimulation fails in 30 % to 50 % of patients , the outcome that remains largely unreported . OBJECTIVE : We report on the management and outcome of this cohort of patients . DESIGN AND INTERVENTIONS : Ninety-one patients ( 88 females ) with fecal incontinence , median age 63 years ( range , 37–81 ) , were c and i date s for sacral nerve stimulation .  The follow-up protocol comprised incontinence and quality -of-life scores . MAIN OUTCOME MEASURES : Failure was defined on an intention-to-treat basis : after the test ( < 50 % decrease of fecal incontinence episodes ) or after permanent implantation ( Wexner score > 8) . Subsequent management and functional results were recorded . RESULTS : The mean Wexner score for the cohort decreased from 14.3 at baseline to 7.6 after a median follow-up of 31 months ( range , 11–69 ) . Sixty-one ( 67.0 % ) patients were implanted with a permanent pacemaker ; 36 ( 39.6 % ) achieved success ( group 1 ) . Failure after permanent implantation occurred in 25 ( 27.5 % ) patients after a mean of 34.5 months ( group 2 ) . Failure after the test occurred in 30 ( 33.0 % ) patients , 12 of whom underwent further surgery ( group 3 ) ( including stoma , 2 ; anal reconstruction , 9 ; and rectopexy , 1 ) , whereas the remainder chose conservative treatment ( group 4 ) . At the end of follow-up , group 1 had significantly lower Wexner scores compared with the rest ( P < .0001 ) and superior Fecal Incontinence Quality of Life scores compared with groups 2 and 4 ( P < .0001 ) . Group 3 achieved a greater reduction in Wexner scores compared with groups 2 and 4 ( P = .04 ) , although the improvement in Fecal Incontinence Quality of Life scores did not reach statistical significance . LIMITATIONS : This was a nonr and omized study with retrospective stratification of patients . CONCLUSIONS : On an intention-to-treat basis , success can be achieved in up to 40 % of patients undergoing sacral nerve stimulation . In those in whom sacral nerve stimulation fails , further surgical treatment can yield favorable results in adequately motivated patients PURPOSE : Percutaneous tibial nerve stimulation has been shown to be an effective treatment in patients with urinary disorders , but its benefit in fecal incontinence is uncertain . This study aim ed to assess the efficacy of percutaneous tibial nerve stimulation in the treatment of urge fecal incontinence . METHODS : This prospect i ve study , conducted over a 14-month period , assessed 31 patients with urge fecal incontinence treated with percutaneous tibial nerve stimulation .  The outcomes measured were : 1 ) reduction in fecal incontinence episodes , 2 ) improvement in Clevel and Clinic incontinence scores , and 3 ) improvement in ability to defer defecation . All analysis was performed on an intention-to-treat basis . RESULTS : The median follow-up was 9 months ( range , 3–14 ) . Twenty-one ( 68 % ) patients improved following percutaneous tibial nerve stimulation and remain satisfied with the clinical response . Median fecal incontinence episodes per week declined from 4 ( range , 0–30 ) to 0 ( range , 0–27 ) ( P < .0001 ) . Median Clevel and Clinic incontinence scores declined from 13 ( range , 5–20 ) to 7 ( range , 0–20 ) ( P < .0001 ) . Ability to defer defecation was improved significantly ( P < .0001 ) . No morbidity was encountered for any patient . CONCLUSION : This preliminary study demonstrates that percutaneous tibial nerve stimulation is an effective and very well tolerated treatment for patients with urge fecal incontinence with particular improvement in reducing fecal urgency Objective Fa 
    Output:
    
SNS , PTNS and TTNS techniques also result ed in improvements in Clevel and Clinic Incontinence Score and quality -of-life measures .
Emerging data for SNS suggest maintenance of its initial therapeutic effect into the long term .
The clinical effectiveness of PTNS is comparable to that of SNS at 12 months , although there is no evidence to support its continued effectiveness after this period .
PTNS may be a useful treatment before SNS .