The evidence on percutaneous tibial nerve stimulation (PTNS) for faecal incontinence raises no major safety concerns. There is evidence of efficacy in the short term in a limited number of patients. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake PTNS for faecal incontinence should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having PTNS for faecal incontinence (see section 3.1).
This procedure should only be carried out in units specialising in the assessment and treatment of faecal incontinence, as one of a range of treatment options.
The Committee was advised that further research is in progress. Future research should clearly define the patient groups being treated and should explicitly address treatment schedules. Studies should report long-term outcomes and requirements for retreatment. NICE may review this guidance on publication of further evidence.