LAUSR

Sacral neuromodulation is an established intervention for faecal incontinence (FI). This investigation aimed to determine the relationship between patient satisfaction and (1) device status (active/inactive) and (2) long-term functional outcomes. Patients treated with sacral neuromodulation for at least 5 years reported bowel habits, FI severity, and impact on quality of life via bowel diaries, St. Marks incontinence score, and the Manchester Health Questionnaire at baseline and follow-up. On all measures, lower scores represent favourable outcomes. Satisfaction since treatment initiation and over the preceding 2 weeks was assessed using visual analogue scales (0%-100%). Individuals with inactive devices were awaiting battery revision surgery due to service delays encountered during the COVID-19 pandemic. In total, 74/110 eligible individuals completed follow-up measures (median: 130 months). Median overall satisfaction was high at 80% (IQR:60%-95%, n=70). Median two-week satisfaction was 75% (IQR:40%-90%, n=50) for individuals with active devices, and 20% (IQR:0%-45%, n=17) for those with inactive devices. Between-group differences were significant for two-week satisfaction (p<0.001), but not overall satisfaction (p=0.114). Two-week satisfaction was negatively correlated with all outcome measures (FI episodes: -0.46, faecal urgency episodes: -0.52, St. Marks incontinence score: -0.68, Manchester Health Questionnaire: -0.62 [all p<0.001]). However, of 12 individuals with active devices who did not meet the conventional treatment success threshold (50% FI reduction), 4 still reported ≥80% two-week satisfaction. Standardised outcome measures reflect subjective satisfaction but cannot be used alone to assess positive outcomes as perceived by patients. Timely device revision is imperative for continued success of treatment.