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IntroductionFaecal incontinence (FI) is a common condition with a significant impact on quality of life (QoL). Neuromodulation treatments delivered by members of the multidisciplinary team including sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS) are options for FI refractory to conservative management. The aim of this study was to assess whether a successful treatment with one neuromodulation modality corresponds with success in the other.MethodsA retrospective review of a prospectively managed neuromodulation database identified 15 patients who had undergone both PTNS and SNS. The definition of success of each treatment was a >50% improvement in any of The St. Mark's Incontinence Score, Manchester Health Questionnaire, or weekly faecal urgency or FI episodes.ResultsComplete data from 12 patients was available for assessment and PTNS was delivered as the first treatment in nine patients. Overall, seven patients (58%) had successful PTNS treatment, with 10 (83%) having a successful SNS trials. Of the seven patients who had successful PTNS treatment, six patients (85.4%) went on to have success with SNS. Of the five patients who failed PTNS, four (80%) went on to have SNS success. Five (71%) of those who had positive PTNS outcomes had permanent SNS implantation as their final treatment decision.ConclusionThis study suggests that there is no clear relationship between successful PTNS treatment and an SNS trial period which may be explained by differing mechanisms of action or the potential placebo effect of PTNS. Further work is required to investigate any association in larger studies to inform clinical practice.

Abstract Molybdenum (Mo) is an essential micronutrient required for plant growth but is prone to leaching from neutral and alkaline soils. The use of slow-release Mo sources could potentially reduce leaching losses from soils and increase crop yields. In this study, we assessed mechanochemistry as a green method to produce slow-release Mo sources. Molybdenum compounds (MoO3 or (NH4)6Mo7O24·4H2O) were mechanochemically (MC) treated with ZnO to synthesize compounds with a Mo content of 1–36%. Reduced Mo solubility after MC treatment, compared to the initial Mo source, was obtained with the MoO3 source and these composites were used for co-compaction with macronutrient fertilizers. Macronutrient pellets with 0.2% Mo were compacted using the 4% Mo and 36% Mo (characterized as ZnMoO4) compounds. A column dissolution test showed that the 4% Mo compound in a macronutrient carrier (DAP and MAP) only released around 40% of the total Mo compared to 80% for a non-MC treated control over 72 h. Column leaching using two soils revealed that the release behavior of Mo was strongly related to the pH of the leachate, which was affected by both the soil pH and the macronutrient carrier. More Mo was released when the MC-treated compound was co-compacted with diammonium phosphate (DAP) compared to monoammonium phosphate (MAP). The MC-treated compound with 4% Mo showed significantly less leaching than the control without ball milling when co-compacted with both MAP and DAP. In a pot trial with simulated leaching, the uptake of Mo was greater for the MC-treated 4% Mo compound co-compacted into DAP than for the other Mo sources. Overall, our results indicate that MC-treated MoO3–ZnO could be used as a slow-release Mo source in high-rainfall areas. Graphical Abstract