Fecal Incontinence Care Pathway Alexandra Rogers MD www

Fecal Incontinence Care Pathway Alexandra Rogers MD www. bladderboutique. com Initial Assessment Medical History and Physical Exam, Gastroenterology Evaluation Conservative Therapies Antidiarrheals Dietary changes Fiber supplements Scheduled Stooling Adequately Managed Continue Conservative Therapies Inadequately Managed Re-Evaluation in the Office Sacral Neuromodulation Outpatient Surgical Implant Phase 1 Testing: Sacral nerve stimulation with 7 day PNE wire procedure or 2 week Surgical Advanced Therapies lead @lower back Phase 2 Surgical Implant: Placement of lead& battery with prior wire test or just battery if prior surgical lead placement Medtronic Device (Therapy since 1997) • ~15 cc battery placed @buttock • Battery lasts about 4 to 7 years (2006) • Outpatient Surgical battery exchange • No MRIs below the neck (*Pending Full Body Device) • Device receiver & smartphone remote management with 7 programs (2018) ~Poor usability per FDA Maude Database *Fail SNM Trial Surgical Sphincteroplasty Axonics Device (FDA Approval in 2019) • ~5 cc battery placed @buttock • Battery lasts about 15 years • Monthly ~1 Hour recharge with belt • Outpatient Surgical battery exchange • Full body MRI conditional • Simple Key Fob MRI Smart remote with 1 program • *Non-recharge Primary cell device pending