Sensory blockade of S3 dermatome prevents pain during bladder catheterization

PURPOSE: We often encounter patients who do not complain of pain on undergoing invasive urogenital or rectal procedures, despite incomplete epidural blockade of sacral cutaneous sensation. To clarify whether or not urethral pain is blocked faster than sacral cutaneous sensation during lumbar epidural anesthesia, we investigated the correlation between occurrence of urethral pain and loss of cold sensation in the S1-3 dermatomes. METHODS: In 46 gynecological patients, Group A (n=22) received 15 ml of 2% mepivacaine via an epidural catheter inserted cephaladly. Group B (n=24) received 5 ml of 2% mepivacaine directly in the epidural needle directed caudally and 10 ml of 2% mepivacaine via the epidural catheter inserted cephaladly. A Foley catheter was inserted into the urethra 30 min after the injection. RESULTS: Urethral pain, which was defined as a pained facial expression and/or complaint of pain, was observed in seven patients in Group A, and none in Group B. The caudad level of epidural blockade was significantly lower in patients without urethral pain (S3, median) than with urethral pain (L4) (P <0.05). In 39 patients without urethral pain, 19 (49%) experienced loss of cold sensation in the S1 dermatome, 27 (69%) in the S2 and 38 (97%) in the S3 25 min after the injection. CONCLUSION: Blockade of urethral visceral pain often occurs before complete sacral somatosensory blockade, and S3 somatosensory blockade is the important sacral level as an indicator of successful urethral sensory blockade.     

A case of chordoma in association with rectal carcinoma

A 74-year-old male patient presented with anal and sacral pain 18 months after abdomino-perineal resection for rectal cancer. Computerized tomography (CT) of the pelvis demonstrated a well defined mass anterior to the lower sacrum, posteriorly infiltrating and destroying the fourth and fifth sacral nerves and invading the right gluteal fossa. A 7.5 x 15 x 2 cm encapsulated mass was demonstrated during the operation using a posterior approach and the lower sacral segments together with the tumour were removed by amputation at S3 level. Histopathology revealed chordoma. This case is unique because of the rarity of chordoma in association with rectal tumour at the sacrococcygeal region.     

Ureteroscopic treatment of urological calculi under sacral block anesthesia

We evaluated the effectiveness and safety of ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of urological calculi under sacral block anesthesia. URS-PL was performed with a semirigid ureteroscope under sacral block anesthesia in 90 patients between January 2006 and April 2010. Calculi were located in the middle ureter in 20 patients, the distal ureter in 48 patients, the bladder in 20 patients, and the urethra in 2 patients. We carried out URS-PL in all patients under sacral block anesthesia with 20 ml 2% lidocaine. An objective pain score scale was used to assess patient pain and anxiety. Adverse events were recorded. The results showed the overall stone-free rate was 97.8%, the rate being 100% for calculi in the bladder, urethral and distal ureter, 90.0% for calculi in the midureter. The mean operative time was 25.2 min (range 10-60 min). We had perfect pain control in the majority of the patients. Patients' acceptance was very high. Only two patient required conversion to epidural block anesthesia. No anesthetic-related side effects occurred in all patients. These finding suggest that sacral block anesthesia is a safe and efficacious mend during URS-PL in urological calculi, especially those patients in the distal ureter and calculi <1 cm.     

The transsphincteric and transsacral approaches for the surgical excision of rectal and presacral lesions

In the decade from 1981 to 1990, 30 patients underwent a posterior transsacral approach at the Aichi Medical University Hospital for their benign or malignant rectal lesions. The operation was classified into two procedures, consisting of the transsphincteric approach and transsacral approach, in order to cope with the condition of the anal sphincter muscles; whether they were divided or not. Eleven rectal tumors were successfully excised through the opened-up rectum by using the transsphincteric approach, and excellent results were obtained without any postoperative complications. Using the transsacral approach, 2 presacral dermoid cysts and 11 rectal lesions were easily removed under direct vision. Their prognoses were excellent. The transsacral approach was also applied for the resection of recurrent rectal cancers after a radical abdominoperineal resection in 6 patients suffering from intolerable local symptoms. All the patients were free from these uncomfortable local symptoms after the surgery. The posterior transsacral operation is thus considered to be of value not only for resecting benign rectal and presacral lesions, but also for resecting malignant rectal tumors in frail subjects who are unfit for radical operation and/or recurrent rectal cancer.     

超声引导经骶后孔骶丛阻滞在骨科手术中的应用

目的 初步总结经骶后孔入路骶丛神经阻滞在骨科手术中的应用方法、效果和经验。方法 回顾我院2016年8月至2017年4月期间27例人工髋关节置换术,1例关节镜下臀肌挛缩松解术及1例臀部包块切除术的临床资料,均行神经阻滞麻醉,复合或单凭骶后孔入路骶丛阻滞,总结阻滞方法、麻醉效果、骶后孔局麻药容量以及并发症情况。结果 经骶后孔入路骶丛阻滞可在超声引导下准确快速的进行,局麻药容量不超过20ml。27例人工髋关节置换术,有3例因术中追加舒芬太尼后仍有不适而改为喉罩全麻。剩余手术均在神经阻滞下完成,为提高患者舒适度,均复合轻度镇静。所有患者手术结束时切口镇痛满意,术后随访未出现局麻药中毒、骶尾部血肿、蛛网膜下腔阻滞、术后感觉运动异常等并发症。结论 超声引导下经骶后孔骶丛阻滞,可安全应用于骨科髋部及臀部手术,麻醉及镇痛效果满意。     

Anesthetic effect of epidural anesthesia with cephalad or caudad catheterization for ankle surgery or hemorrhoidectomy

BACKGROUND: The larger size of the first sacral nerve root has been reported to be an unfavorable factor leading to sacral sparing in epidural anesthesia. Previous studies have shown that an adequate analgesic effect of the epidural block was achieved with the catheter placement in the caudal direction. In this study, the anesthetic effect of epidural anesthesia with catheter placement of a cephalic or caudad direction was compared in ankle and hemorrhoid surgery. METHODS: Twenty-one ASA physical status I or II patients undergoing surgery for ankle fractures with epidural anesthesia were enrolled and randomized into two groups. The epidural catheter was placed either to a cephalad (AU group) or caudal (AD group) direction. Another 21 patients undergoing hemorrhoidectomy were also randomized into two groups to receive epidural anesthesia in a similar way (HU and HD groups). The onset for, duration of, and recovery time from epidural anesthesia and the incidence of analgesic request were recorded. RESULTS: No significant differences were demonstrated when age, height, weight or sex were compared between the four study groups. The onset time of the block and the incidence of intrasurgical analgesic request were lower in the caudal subgroup when the ankle surgery patients were compared. Otherwise, there were no significant differences in the duration of anesthesia and time to recovery or level of anesthesia. CONCLUSION: Injection of local anesthetic solution through a caudally oriented epidural catheter produces faster onset and superior quality of anesthesia in comparison with the injection through the cephaladly oriented catheter in ankle surgery, but not hemorrhoidectomy.     

Management of severe reflux in the patient with cyclophosphamide cystitis

To determine whether the minimum urethral resistance was useful to identify bladder outlet obstruction in prostatectomy candidates, 46 patients undergoing transurethral resection of the prostate were evaluated by means of detailed symptom analysis, cystoscopy, rectal examination and post-void residual urine determination. In addition, each patient underwent extensive urodynamic testing, the results of which were not made available to the operating urologist as patients were selected for surgery. This prospective, blind evaluation has been completed in 33 and 15 patients 3 and 12 months postoperatively, respectively. A correlation is noted between the minimum urethral resistance, and symptomatology and uroflowmetry but no correlation was identified with prostatic length and the resected prostatic weight. The minimum urethral resistance was not useful in predicting which patients would benefit from transurethral resection of the prostate. It is concluded that symptom analysis generally is a better predictor of the outcome of transurethral resection of the prostate than is minimum urethral resistance.     

Treatment of priapism with intracavernous injection of etilefrine hydrochloride

A case of priapism following epidural anesthesia was reported. A 67 year old man received epidural anesthesia for the transurethral resection of a malignant bladder tumor. Epidural anesthesia which he had wanted to receive was given through the L3 to L4 intervertebral space with 18 ml of 2% lidocaine. The penile erection occurred while he was prepared and draped. Additional 8 ml of 1% lidocaine failed to overcome it and the operation cancelled. After this episode, he had anesthesia on 5 occasions in 2 years. General anesthesia was given 3 times without penile erection, but epidural block was tried on 2 occasions, which was followed by penile erection. For the penile erection, intracavernous injection of etilefrine hydrochloride was effective and surgical procedure could be done smoothly. The mechanism of priapism remained unclear but imbalance of the autonomic nervous system may be a involved. This case suggests that intracavernous injection of etilefrine hydrochloride is effective for treatment of penile erection during transurethral surgery.     

Abdominosacral Approach for Retrorectal Tumors

The relative rarity and anatomical position of retrorectal tumors may lead to difficulty in diagnosis and surgical treatment. The clinical features and management of 20 such tumors (chordoma 8, neurilemmoma 3, teratoma 3, hemangiopericytoma 1, chondrosarcoma 1, osteosarcoma 1, dermoid 1, lipoma 1, and undifferentiated sarcoma 1) have therefore been reviewed. Low back or sacral pain was present in 18 patients and, although all tumors were palpable on rectal examination, pain had been present for a median of 12 months before diagnosis. Mean tumor size was 9.4 cm (range: 2.5-17 cm). Sacral bone destruction was demonstrated radiographically in all chordomas and three sarcomas, but in none of the benign tumors. Three patients had undergone previous partial removal of their tumors. Surgical resection was carried out using a combined abdominal and transsacral approach in 13, a transsacral approach in the right lateral position in four and transabdominally in three. There was one operative death following secondary operation for chbrdoma. Four of 12 patients with malignant tumors are alive and well at seven months to eight years. One died of a myocardial infarct without recurrence at 11 years. For small benign tumors, the right lateral position permits maximal flexibility for resection either by the transsacral, transabdominal or a combined approach. For bulky or malignant tumors, a combined abdominal transsacral approach in the right lateral position permits vascular control and provides good exposure for protection of vital structures and wide resection.     

Miles会阴切除术的技术改进

目的探讨肛管直肠癌会阴切除术(PR)的技术改进方法和临床应用价值。方法对126例按常规进行腹会阴联合根治术(APR,常规手术组)和153例按技术改进方法(技术改进组)进行手术的病例资料进行回顾性分析。结果常规手术组术中、术后大出血12例(9.5%),技术改进组3例(2.0%)。常规手术组术中切破肠壁27例(21.4%),切破肿瘤19例(15.1%),输尿管损伤4例(3.2%),前列腺损伤11例(8.7%),后尿道损伤5例(4.0%);技术改进组术中切破肠壁7例(4.6%),切破肿瘤5例(3.3%),无输尿管损伤,前列腺损伤4例(2.6%),无后尿道损伤。常规手术组死亡1例;技术改进组无死亡者。常规手术组会阴切口延迟愈合49例(38.9%),局部复发16例(12.7%);技术改进组会阴切口延迟愈合22例(14.4%),局部复发11例(7.2%)。两组术后并发症发生率比较差异有显著性意义(P<0.01)。结论PR技术改进可降低术后各种并发症的发生率。     

A comparison of combined spinal-epidural anesthesia with epidural anesthesia for postoperative pain relief after transurethral resection of the prostate

BACKGROUND: We compared combined spinal-epidural anesthesia (S group) and epidural anesthesia (E group) in terms of pain control after transurethral resection of the prostate (TUR-P). METHODS: All 32 patients received 0.2% ropivacaine at a rate of 2 ml x hr(-1) by a portable disposable pump postoperatively. RESULTS: S group was superior to E group in urethral pain control within three hours after operation. E group was superior to S group in decrease of back pain over six hours after operation. Fifteen patients (47%) suffered from irritability or low back pain and needed rescue analgesics. CONCLUSIONS: Our result indicates that 0.2% ropivacaine at a rate of 2 ml x hr(-1) is not satisfactory to relieve the postoperative pain. Long acting local anesthetics for spinal anesthesia are not suitable for TUR-P. Supplemental administration of opioid to epidural space or higher rate of continuous epidural infusor after operation might be better analgesic choice for TUR-P.     

经尿道膀胱肿瘤电切术中预防闭孔神经反射致膀胱穿孔的不同方法介绍

目的总结经尿道膀胱肿瘤电切术中,应用各种闭孔神经反射预防方法避免膀胱穿孔的经验。方法回顾性分析总结我院自2007年1月至2009年12月在经尿道膀胱肿瘤电切术中,应用闭孔神经反射预防方法的临床资料。经尿道膀胱肿瘤电切术的患者186例,男性115例,女性71例,年龄27～87岁,平均54岁。膀胱左侧或右侧壁单发肿瘤134例,膀胱多发表浅性肿瘤52例,根据患者采用的麻醉方法被分成三组,其中第一组应用硬膜外麻醉和肌松药及面罩给氧56例,第二组应用全身麻醉104例,第三组应用硬膜外麻醉和闭孔神经阻滞麻醉26例。结果 186例患者中,第一组有6例出现轻微的闭孔神经反射,未造成膀胱穿孔,有5例出现严重的闭孔神经反射,造成轻微的膀胱穿孔4例,不需要膀胱修补,造成2例严重的膀胱穿孔,1例大出血,需要进行膀胱修补术。第二组出现2例轻微的闭孔神经反射,造成轻微的膀胱穿孔,不需要膀胱修补。第三组造成1例严重的膀胱穿孔,需要进行膀胱修补术。结论硬膜外麻醉是不能抑制闭孔神经反射的,肌松药的应用可以抑制膀胱肌肉的收缩,对大的表浅性膀胱肿瘤或多发的表浅性膀胱肿瘤,应用全身麻醉是非常适合的。闭孔神经阻滞麻醉和硬膜外麻醉的联合应用是经济的方法,但闭孔神经阻滞不全,效果不佳是出现闭孔神经反射的原因。     

Selective sacral rootlet rhizotomy for hypertonic neurogenic bladder.

The authors describe a highly selective transsacral microsurgical procedure for sacral nerve rootlet interruption in five patients with hypertonic neurogenic bladder. Magnification and systematic stimulation of sacral roots provided accurate identification of motor fibers supplying bladder detrusor muscle and differentiation of efferent components to the legs and anal sphincter. Although the technique prevented incontinence and adverse effects of nerve section on rectal and lower extremity function improvement in voiding patterns and diminution of urinary sepsis was of brief duration in three of the five patients. Physiological data from these procedures reaffirms the importance of S-3 and S-4 motor roots in detrusor innervation, but clinical responses bring into question the possibility of sustained improvement from such a highly selective procedure at the sacral level. The authors suggest that alternative pathways, not apparent on initial stimulation, may develop after section of sacral root components, and that dissection and stimulation of fibers at the level of the conus medullaris should be investigated as an alternative procedure.     

LOCAL MICROWAVE HYPERTHERMIA AND INTRAVESICAL CHEMOTHERAPY AS BLADDER SPARING TREATMENT FOR SELECT MULTIFOCAL AND UNRESECTABLE SUPERFICIAL BLADDER TUMORS

Purpose

The role of a combined regimen of local hyperthermia and topical chemotherapy in patients with multifocal and recurrent superficial bladder tumors not curable by transurethral resection was evaluated in a neodjuvant organ sparing clinical study.

Materials and Methods

A total of 19 patients with multifocal, superficial grades 1 to 3 bladder tumors that recurred after intravesical chemoprophylaxis or immunoprophylaxis underwent local combined administration of microwave induced hyperthermia and intravesical chemotherapy as a debulking approach. Due to extensive superficial involvement of the bladder walls complete transurethral resection of all tumors seemed technically unfeasible in all cases and radical cystectomy was considered the treatment of choice. Endovesical hyperthermia at 42.5 to 46C was delivered using the SB-TS 101 system,* based on a microwave transurethral applicator that irradiates the bladder filled with a circulating solution of mitomycin C. Patients underwent 8 weekly 1-hour sessions on an outpatient basis without anesthesia. When possible, after treatment patients underwent transurethral resection of residual tumors and all suspicious areas.*Boston Scientific Corp., Natick, Massachusetts.

Results

After treatment transurethral resection appeared to be feasible and curative in 16 patients (84%). Histological study revealed complete and partial responses in 9 (47%) and 7 (37%) cases, respectively. Due to extensive residual tumors radical cystectomy was performed in 3 patients (16%). At a median 33-month followup 8 superficial transitional tumor recurrences were documented and easily eradicated by transurethral resection or laser therapy in patients in whom the bladder had been saved.

Conclusions

Microwave induced hyperthermia combined with intravesical mitomycin C seems to be a feasible, safe and elective approach for conservative treatment of multifocal and recurrent superficial bladder tumors when other treatment strategies have failed.     

Relief of intractable perineal pain by coccygeal nerve block in anterior sacrococcygeal ligament after surgery for rectal cancer

Intractable perineal pain often appears in the anal region following abdominoperineal resection for the treatment of rectal cancer. In such cases, a subarachnoid block or transsacral block is generally used to control pain. However, these procedures sometimes cause complications such as dysuria or sensory paralysis of the pudendum. A new method of pain control is presented herein using absolute alcohol as a neurolytic agent to relieve localized perineal pain through a coccygeal nerve block in the anterior sacrococcygeal ligament. Five cadavers were necropsied to localize the coccygeal nerve. A loop consisting of S4, S5, and Co was found to exist in the space surrounded by the anterior surface of the coccygeal bone and the anterior sacrococcygeal ligament. Absolute alcohol was injected into this space. It is essential that the neurolytic agent remain localized in this space to avoid complications and to successfully block perineal pain. In all patients, we found that this method was extremely effective in blocking localized perineal pain without any complications.     

经尿道双极等离子电切术与剜除术治疗非肌层浸润性膀胱癌的病例对照研究

目的对比经尿道膀胱肿瘤等离子电切术（TURBT）与经尿道膀胱肿瘤等离子剜除术（TUEBT）治疗非肌层浸润性膀胱肿瘤（NMIBT）的临床疗效。 方法回顾性分析中山大学附属第三医院粤东医院2013年8月至2017年8月的160例经尿道膀胱肿瘤切除的资料,所有患者术前临床分期均为T1N0M0,其中TURBT和TUEBT各80例,采用全麻或腰硬联合麻醉联合闭孔神经阻滞,行经尿道膀胱肿瘤电切或剜除术。 结果术前两组的临床资料差异无统计学意义,两组患者均顺利完成手术,无输血病例。无严重并发症（膀胱穿孔、严重闭孔神经反射）发生。TURBT组和TUEBT组在手术时间、膀胱穿孔率、术后肿瘤病理分级、术后病理T分期、术后随访时间上差异均无统计学意义,而在术中失血[（15±7）ml vs（6±2）ml,P<0.05],住院天数[（5.8±2.3）d vs（3.6±1.4）d,P<0.05],二次电切率（70.00%vs 36.25%,P<0.05）,二年内肿瘤复发率（47.50%vs 31.25%,P<0.05）差异有统计学意义。 结论TURBT与TUEBT均是安全、有效的处理NMIBT的手术方法,但TUEBT大多数标本含有肌层,有利于判断分期,减少了二次电切率,缩短住院时间,降低术后复发率。     

Videomanometry of the pelvic organs: A comparison of the normal lower urinary and gastrointestinal tracts

BACKGROUND: Both the lower urinary tract (LUT) and the caudal part of the lower gastrointestinal tract (LGIT) are innervated by the sacral spinal cord. We aimed to compare the normal physiology of the LUT and LGIT using the same videomanometry method. METHODS: We recruited fifteen healthy volunteers (eight men and seven women; mean age, 60 years). The videomanometric measures included fluoroscopic images, subtracted bladder/rectal pressures, urethral/anal sphincter pressures, sphincter electromyography, and urinary/fecal flow. RESULTS: During the resting phase, the urethral/anal sphincter pressures showed almost the same values (mean, 70 cmH2O and 68 cmH2O, respectively). During the storage phase, the volumes at first sensation and maximum capacity for the LGIT (129 mL and 320 mL) were slightly smaller than those for the LUT (170 mL and 405 mL). Compliance of the LGIT (65 mL/cmH2O) was almost as high as that of the LUT (99 mL/cmH2O). However, the LGIT showed spontaneous phasic rectal contractions (SPRC) that were never seen in the bladder. None of the subjects experienced leakage during bladder/rectal filling. During the evacuation phase, rectal contraction on defecation (14 cmH2O) was present, but was weaker than bladder contraction on micturition (42 cmH2O; P < 0.01). Abdominal strain on defecation (70 cmH2O) was greater than that on micturition (25 cmH2O; P < 0.01). Sphincter pressure increase on defecation (13 cmH2O) was greater than that on micturition (-52 cmH2O). An illustrative case of SPRC that were seen during urodynamic recording was shown. CONCLUSION: SPRC and abdominal strain are features of the LGIT, whereas micturition bladder contraction is a feature of the LUT. These features can aid in understanding the possible rectal 'artifacts' of videourodynamics and neurogenic pelvic organ dysfunction.     

经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效比较

目的　比较经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效及安全性。方法　随机选取 32例膀胱肿瘤患者行经尿道钬激光切除 ,另 2 7例行经尿道电切 ,总结两组患者临床资料 ,并对手术时间、导尿管留置时间、术后膀胱冲洗例数、肿瘤复发情况、肿瘤分期、膀胱穿孔例数、尿道外口狭窄发生率等指标进行比较。　结果　钬激光组手术时间 15～ 5 0min ,平均 2 5min ,膀胱穿孔 1例 ;术后无需膀胱冲洗 ;导尿管留置时间 1～ 4d ,所有患者均获得肿瘤分期 ;随访 1年 ,无尿道狭窄 ,复发 7例。电切组手术时间 10～ 5 5min ,平均 2 8min ,膀胱穿孔 6例 ,术后 5例需膀胱冲洗 ,导尿管留置时间 1～ 6d ,7例获得肿瘤分期 ;随访 1年 ,尿道狭窄 3例 ,复发 8例。两组平均手术时间、导尿管留置时间、术后肿瘤复发、尿道狭窄发生率均无明显差异 (P >0 .0 5 ) ,钬激光组获得准确肿瘤分期例数明显多于电切组 ,而膀胱穿孔及术后膀胱冲洗例数明显少于电切组 (P <0 .0 5 )。　结论　钬激光是一种治疗膀胱肿瘤高效、安全的方法 ,在准确判断肿瘤分期、减少膀胱穿孔及减少出血方面比电切更优越。     

直肠局部切除术治疗直肠良恶性肿瘤(附44例报告)

目的:探讨直肠局部切除术在直肠良恶性肿瘤治疗中的应用。方法:回顾性分析1998年1月至2005年12月收治的44例中、低位直肠良恶性肿瘤的临床资料。经骶尾后入路局部切除24例;经肛局部切除17例。对于3例直肠多发性病灶的患者,经腹局部扩大切除多发性病灶1例,同时经骶尾后入路和经肛局部切除1例,同时经腹和经肛局部切除1例。结果:术后病理学诊断显示直肠管状绒毛状腺瘤伴上皮异型增生17例(其中多发性腺瘤1例);直肠管状绒毛状腺瘤癌变11例;直肠类癌9例;直肠早期腺癌1例;直肠恶性黑色素瘤1例;直肠间质瘤1例;增生性息肉4例(其中多发性息肉2例)。全组44例患者切口均I期愈合。无肛门失禁发生。在25例经骶尾后入路局部切除的患者中,2例并发粪瘘(2/25,8%),均于术后1月痊愈。经骶尾后入路局部切除的2例直肠腺瘤患者,术后1年出现复发(2/25,8%),1例追加Parks术,1例再次经肛局部扩大切除。结论:直肠局部切除术在直肠良恶性肿瘤的外科治疗中应用广泛,是保留肛门功能手术的最佳选择之一。     

Sacral Nerve Stimulation in Patients After Rectal Resection—Preliminary Report

Introduction Sacral nerve stimulation is a widely accepted therapeutic option for neurogenic fecal incontinence. More recently, case reports showed a positive effect of sacral nerve stimulation in patients with fecal incontinence following low anterior resection. The purpose of this study was to gain more information for this selected indication for sacral nerve stimulation through a nationwide survey. Material and methods In the period 2002 to 2005, three Austrian departments reported data of patients who underwent SNS for fecal incontinence following rectal resection. Data were available of seven patients (two female, five male) with a median age of 57 years (min 42; max 79). Six patients had undergone rectal resection as a treatment for low rectal cancer. One patient had undergone rectal resection for Crohn’s disease, one patient subtotal colectomy and ileorectostomy for slow colon transit constipation. Results Test stimulation was performed in the foramen S3 unilaterally over a median period of 14 days (2–21 days). Seven patients reported a marked reduction of episodes of incontinence during the observation period and received a permanent stimulation system. After a median follow-up of 32 months (17–46), five patients reported a marked improvement of their continence situation. Conclusion Despite a nationwide survey experiences with SNS as a treatment for fecal incontinence following rectal resection is still limited. Our observations show an improvement of the continence function following SNS. However, the promising results of our series as well as others need further research and more clinical data by a larger number of patients in a prospective trial.