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1
Sacral neuromodulation (SNM) is used for fecal incontinence, low anterior resection syndrome, and bowel dysfunction, but faces challenges like variability in response and loss of efficacy.
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2
Loss of efficacy (LOE) in SNM is defined as deterioration after initial benefit, requiring specific conditions to be met for clinical relevance.
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3
Functional LOE occurs despite intact hardware, necessitating reassessment before considering device revision or explantation.
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4
Neuroadaptive drift and phenotype mismatch are proposed hypotheses explaining reduced response to SNM over time, highlighting the need for ongoing evaluation.
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5
The paper focuses on coloproctological SNM practice, particularly for fecal incontinence and low anterior resection syndrome, excluding certain constipation phenotypes.
