{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T16:09:17Z","timestamp":1749053357279},"reference-count":89,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n            Hintergrund Die sakrale Neuromodulation (SNM) hat sich in den letzten 2 Jahrzehnten fest in der Therapie funktioneller Beckenbodenerkrankungen etabliert. Trotz nicht vollst\u00e4ndig\n            gekl\u00e4rtem Wirkungsmechanismus ist sie zum bevorzugten Verfahren in der chirurgischen Therapie der Stuhlinkontinenz geworden.<\/jats:p><jats:p>\n            Methoden und Ergebnisse Es wurde eine aktuelle Literaturanalyse zur Schrittmacherprogrammierung sowie zu Langzeitergebnissen der SNM bei Stuhlinkontinenz und Obstipation\n            durchgef\u00fchrt.<\/jats:p><jats:p>Die SNM bei Stuhlinkontinenz zeigt sich auch im Langzeitverlauf erfolgreich. \u00dcber die Jahre konnte das Indikationsspektrum auf Patienten mit Sphinkterl\u00e4sionen ausgeweitet werden. Die\n            Anwendung beim Low Anterior Resection Syndrome (LARS) nach Rektumresektion ist aktuell in klinischer Erprobung. Bei den verschiedenen Formen der Obstipation hingegen ist die Wirkung der\n            SNM nicht eindeutig belegbar. In mehreren randomisierten Cross-over-Studien konnte kein Erfolg nachgewiesen werden, auch wenn dieser m\u00f6glicherweise f\u00fcr Untergruppen der Obstipation\n            besteht. Zum jetzigen Zeitpunkt kann die Anwendung nicht allgemein empfohlen werden.<\/jats:p><jats:p>Die Schrittmacherprogrammierung definiert Elektrodenkonfiguration, Stimulationsamplitude, Pulsfrequenz und Pulsbreite. W\u00e4hrend die Einstellung von Pulsfrequenz und -breite eher anhand\n            standardisierter Werte erfolgt und meist als Niederfrequenzstimulation mit einer Frequenz von 14\u00a0Hz und einer Pulsbreite von 210\u00a0s durchgef\u00fchrt wird, werden Elektrodenkonfiguration und\n            Stimulationsamplitude individuell an den einzelnen Patienten angepasst. Insbesondere im 1. postoperativen Jahr k\u00f6nnen Reprogrammierungen aufgrund von Wirkungsverlust oder Nebenwirkungen\n            erforderlich werden.<\/jats:p><jats:p>Trotz geringer H\u00e4ufigkeit von Infektionen und Elektroden-\/Impulsgeberfehlfunktionen ben\u00f6tigen im Langzeitmanagement bis zu 65% der Patienten operative Revisionen. Diese sind bei etwa 50%\n            bedingt durch erwartbare Batterieersch\u00f6pfung des Impulsgebers. Auch mindestens eine Reprogrammierung wird bei 75% der Patienten im Verlauf erforderlich, meist aufgrund einer\n            Wirkungsver\u00e4nderung, seltener aufgrund von Schmerzen. Regelm\u00e4\u00dfige Nachuntersuchungen sind empfehlenswert.<\/jats:p><jats:p>\n            Schlussfolgerung Die SNM hat sich in der Langzeittherapie der Stuhlinkontinenz als sicheres und erfolgreiches Verfahren bew\u00e4hrt. Um einen optimalen Therapieerfolg zu erzielen, ist\n            eine strukturierte Nachsorge erforderlich.<\/jats:p>","DOI":"10.1055\/a-2063-3630","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T22:40:17Z","timestamp":1685745617000},"page":"228-236","source":"Crossref","is-referenced-by-count":3,"title":["Sakralnervmodulation in der Therapie der Stuhlinkontinenz und Obstipation: Evidenz, Programmierung und Langzeitmanagement"],"prefix":"10.1055","volume":"148","author":[{"given":"Birgit","family":"Bittorf","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Erlangen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Matzel","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Erlangen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/s0022-5347(17)38751-7","article-title":"Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders","volume":"142","author":"EA Tanagho","year":"1989","journal-title":"J Urol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1016\/s0140-6736(95)91799-3","article-title":"Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence","volume":"346","author":"KE Matzel","year":"1995","journal-title":"Lancet"},{"key":"ref3","volume-title":"Incontinence","year":"2017","edition":"6"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1002\/ueg2.12213","article-title":"Guideline for the diagnosis and treatment of faecal incontinence \u2013 a UEG\/ESCP\/ESNM\/ESPCG collaboration","volume":"10","author":"SL Assmann","year":"2022","journal-title":"United European Gastroenterol J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1097\/MCG.0000000000000850","article-title":"Sacral neuromodulation for fecal incontinence: a review of the central mechanisms of action","volume":"51","author":"PTJ Janssen","year":"2017","journal-title":"J Clin Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1111\/nmo.12388","article-title":"A systematic review of sacral nerve stimulation mechanisms in the treatment of fecal incontinence and constipation","volume":"26","author":"EV Carrington","year":"2014","journal-title":"Neurogastroenterol Motil"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1111\/codi.15390","article-title":"The science behind programming algorithms for sacral neuromodulation","volume":"23","author":"CH Knowles","year":"2021","journal-title":"Colorectal Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00053-014-0462-9","article-title":"Sakralnervenstimulation in der Koloproktologie","volume":"37","author":"KE Matzel","year":"2015","journal-title":"Coloproctology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/j.1463-1318.2009.02088.x","article-title":"Factors affecting the outcome of temporary sacral nerve stimulation for faecal incontinence. 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