Comparative outcomes of sphincteroplasty and sacral neuromodulation in postmenopausal women with late-onset fecal incontinence following obstetric trauma: a retrospective study.

Fecal incontinence (FI) is a debilitating condition that commonly affects postmenopausal women, particularly those with a history of obstetric trauma. To date, there are few studies directly comparing SP and SNM, which present many discrepancies in the inclusion criteria, such as age, etiology, and elapsed time from the onset of the condition. This retrospective study aims to compare the clinical outcomes of the two procedures most widely performed in the management of FI: sphincteroplasty and sacral neuromodulation (SNM). The inclusion criteria were established to ensure a representative sample of a well-defined patient population affected by fecal incontinence: postmenopausal women with late onset of FI after previous obstetric trauma. A cohort of 58 women aged 65 and older treated consecutively at the Humanitas San Pio X Hospital between January 2016 and December 2022 was analysed. Thirty-five women underwent sphincteroplasty, while 23 received SNM. Outcomes were evaluated based on the functional outcomes and the incidence of adverse events. Statistical Analysis did not show any statistically significant differences between the two groups (SP and SNM) in terms of baseline characteristics and 2-year functional outcomes. Both techniques were effective in the treatment of FI according to the Cleveland Clinic Incontinence Score registrations over the 2-year follow-up. No differences were found between the two techniques in terms of both early and late complication rates. Therefore, SP and SNM proved to be safe and effective treatments for late-onset FI in postmenopausal women with a history of obstetric trauma, yielding favourable outcomes at 24 months.