Obstruktives Defäkationssyndrom: Stellenwert der sakralen Neuromodulation

Zusammenfassung

Nach der erfolgreichen Etablierung des sakralen Nervenschrittmachers in der Therapie der fäkalen Inkontinenz zeigten erste Kohortenstudien ebenfalls vielversprechende Ergebnisse in der Therapie der konservativ refraktären chronischen Konstipation und obstruktiven Defäkation. Langzeitdaten wie auch Studien höchster Evidenz konnten diese jedoch nicht bestätigen. So zeigten randomisierte Studien keinen Vorteil einer sakralen Nervenstimulation verglichen mit nicht stimulierten Patienten. Im Langzeitverlauf erleiden viele Patienten einen Wirkverlust oder unerwünschte Ereignisse nach Implantation, die wiederum zu hohen Explantationsraten führen. Aufgrund der aktuellen Studienlage kann der sakralen Nervenstimulation momentan noch kein klarer Stellenwert im Allgemeinen Therapiealgorithmus der chronischen Konstipation und der obstruktiven Defäkation zugeordnet werden. Noch ist unklar, ob und welches Patientenkollektiv von einer sakralen Nervenstimulation (SNS) profitieren könnte. Weitere Studien zur Identifikation möglicher Selektionskriterien für die sakrale Nervenstimulation bei chronischer Konstipation und obstruktiver Defäkation sind hierfür notwendig. Ziel dieses narrativen Reviews ist es, einen Überblick über die aktuelle Datenlage in Hinblick auf den Stellenwert der SNS-Therapie bei der obstruktiven Defäkation als eine Subgruppe der chronischen Konstipation zu geben.

Abstract

After successful implementation of sacral nerve stimulation in the treatment of fecal incontinence, the first cohort studies showed promising results for sacral neuromodulation in the treatment of conservative refractory chronic constipation and obstructed defecation. However, these results have not been confirmed with long-term data or with studies of the highest level of evidence. Randomised trials failed to show any difference between patients with and without sacral nerve stimulation. In the long term, many patients suffer from loss of efficacy or adverse events, leading to high explantation rates. On the basis of existing clinical trials, it cannot be concluded that sacral neuromodulation should be included in the treatment algorithm of chronic constipation and obstructed defecation. So far it is unclear whether and which patient cohort may benefit from sacral nerve stimulation. Therefore further trials are needed to identify possible selection criteria for sacral nerve stimulation in the treatment of chronic constipation and obstructed defecation. The aim of this narrative review is to give an overview of the existing literature on sacral nerve stimulation in chronic constipation and the subgroup of obstructed defecation.

Schlüsselwörter

obstruktives Defäkationssyndrom - chronische Konstipation - sakrale Neuromodulation - sakrale Nervenstimulation

Key words

obstructed defecation - chronic constipation - sacral neuromodulation - sacral nerve stimulation

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