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Session: Super Session Pelvic Floor: Abstracts and Panel/Case Discussion

SS200 - Effects of sacral neuromodulation on non-digestive symptoms of Low Anterior Resection Syndrome: results from a randomized, multicentric, trial.

Sunday, May 11, 2025
9:00 AM – 9:07 AM PT
Location: Ballroom 6C-F, Upper Level

    Presenting Author(s)

  • FM

    Franco Marinello, MD, PhD

    Colorectal Surgeon
    Hospital Universitari Vall d'Hebrón
    Barcelona, Catalonia, Spain

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • PP

    Pere Planellas, MD, PhD

    Colorectal Surgeon
    Hospital Universitari Josep Trueta
    Girona, Catalonia, Spain

    Disclosure information not submitted.

  • DF

    Domenico Fraccalvieri, MD, PhD

    Colorectal Surgeon
    Hospital Universitario Bellvitge
    Hospitalet del Llobregat, Catalonia, Spain

    Disclosure information not submitted.

  • JG

    Júlia Maria Gil, MD

    Colorectal Surgeon
    Hospital Universitari Josep Trueta
    Girona, Catalonia, Spain

    Disclosure information not submitted.

  • EK

    Esther Kreisler, MD, PhD

    Colorectal Surgeon
    Hospital Universitari Bellvitge
    Hospitalet del Llobregat, Catalonia, Spain

    Disclosure information not submitted.

  • NO

    Nuria Ortega, MD

    Colorectal Surgeon
    Hospital Universitari Vall d'Hebrón
    Barcelona, Catalonia, Spain

    Disclosure information not submitted.

  • GP

    Gianluca Pellino, MD, PhD

    Colorectal Surgeon
    Hospital Universitari Vall d'Hebrón
    Barcelona, Catalonia, Spain

    Disclosure information not submitted.

  • Eloy Espin-Basany, MD, PhD

    Colorectal Surgeon
    Hospital Universitari Vall d'Hebrón
    Barcelona, Catalonia, Spain

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Franco Marinello, MD, PhD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Patients with low anterior resection syndrome (LARS) are at risk of developing non-digestive symptoms including urinary incontinence and sexual dysfunction. The SANLARS trial demonstrated that sacral neuromodulation (SNM) is effective to palliate digestive LARS symptoms [1], but the effects on urinary and sexual function have been poorly addressed. We report the impact of SNM on extra-digestive symptoms in LARS patients measured by validated scores within the trial.

Methods/Interventions: The SANLARS was a prospective, randomized, multicentric, controlled, double-blinded crossover clinical trial which included patients with major LARS after failed conservative treatment. Included patients underwent a test phase by stimulation for three weeks with a tetrapolar electrode and received a permanent subcutaneous implanted pulse generator (IPG) if there was at least a 50% reduction in baseline LARS score. Extra-digestive dysfunctions were assessed at baseline, 6 and 12 months follow up. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Sexual function was assessed by International Index of Erectile Function (IIEF-5) in males and the Female Sexual Functional Index (FSFI) in females.

Results/Outcomes: A total of 46 patients (32 men) were included, and 35 of them (76%) received IPG. Almost 49% of patients referred urinary leaks at baseline with a mean ICIQ-SF of 5.09 (6.48) points. At 6- and 12-month follow-up, the score decreased to 2.76 (p=0.002 CI: -3.96; -0.78) and 3.31 (p=0.023 - CI: -3.35; -0.19), with 68% and 63% of patients achieving complete urinary continence, respectively.
Twenty-two men were sexually active and completed the IIEF-5 questionnaire. The mean score at baseline was 11 points (moderate dysfunction) with no changes at follow-up. However, patients reported improvement in getting and keeping an erection during the intercourse. Seven women reported being sexually active with a baseline FISI score of 15.84 points (moderate dysfunction). There were no changes in the total score or any specific domain after SNM.

Conclusion/Discussion: SNM can be recommended in patients with LARS associated to urinary incontinence. Sexual function showed little improvement possibly due to the small sample of patients and complex pathophysiology of sexual disorders.

References
(1) Marinello F, et al. Sacral Neuromodulation in Patients With Low Anterior Resection Syndrome: The SANLARS Randomized Clinical Trial. Dis Colon Rectum. 2024 Mar 1;67(3):435-447. doi: 10.1097/DCR.0000000000003143.