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304 Chapter 15 Constipation treatment The number of patients using oral laxatives decreased from 16 (64%) at baseline to 11 (44%) at follow-up with SNS treatment, but this difference was not statistically significant ( P = .16). Thirteen patients (52%) had an appendicostomy or cecostomy in place at baseline, but only 12 (48%) were regularly using ACE at baseline. At follow-up, the number of patients using ACE had decreased to five (20%, P = .03). Antegrade continence enema use decreased from a median of 7 (IQR 7-7) antegrade enemas per week to 0 (0-3.3, P < .01) at follow-up. Six of 25 patients (24%) fulfilled our criteria for successful response and were no longer receiving laxatives or ACE at follow-up. Four of these six patients had functional constipation and the remaining two patients had organic causes of constipation. Patient-reported outcomes Table 1 compares the three patient-reported measures of symptom severity and quality of life at baseline and follow-up after SNS treatment. Scores were recorded at a median of 1.7 years (IQR 1.4-2.3) after SNS initiation. Three patients (12%) were missing baseline scores and two patients (8%) were missing the FISI score at follow-up. The total GSS score improved significantly ( P = .01), and the constipation, abdominal pain, and abdominal discomfort components of the GSS ( P < .01, P = .02, P = .01 respectively). The Lifestyle, Coping/Behavior, and Embarrassment domains of the FIQL improved significantly ( P < .01,  P < .01,  P < .01 respectively). The FISI improved significantly as well ( P < .01). Complications Six patients (24%) had complications from SNS requiring further surgery. Four patients developed local infection of the subcutaneous pocket created for implantation of the pulse generator. All four patients underwent removal and subsequent replacement of SNS. One patient developed a second infection requiring a second SNS removal. In this patient, SNS was not replaced after it was removed for the second time. Two patients developed displacement or malfunction of the SNS lead and required lead revision. The first of these patients experienced lead displacement after the first stage procedure but prior to permanent implantation of the pulse generator during the second stage. This patient therefore needed a second procedure to reposition the lead, after which the patient experienced improvement in both constipation and urinary symptoms. This patient then underwent a third procedure for permanent implantation of the pulse generator. The second patient who required lead revision had already undergone SNS removal and replacement because of a prior wound infection. Approximately 12 months