MALONE ANTEGRADE CONTINENCE ENEMA FOR ADULTS WITH NEUROGENIC BOWEL DISEASE

Field: Medicine (Health Sciences)

No AccessJournal of UrologyClinical Urology: Original Articles1 Oct 1998MALONE ANTEGRADE CONTINENCE ENEMA FOR ADULTS WITH NEUROGENIC BOWEL DISEASE JOEL M.H. TEICHMAN, J. MANSEL HARRIS, DONALD M. CURRIE, and DOUGLAS B. BARBER JOEL M.H. TEICHMANJOEL M.H. TEICHMAN More articles by this author , J. MANSEL HARRISJ. MANSEL HARRIS More articles by this author , DONALD M. CURRIEDONALD M. CURRIE More articles by this author , and DOUGLAS B. BARBERDOUGLAS B. BARBER More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62515-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We describe the outcomes of adults with neurogenic bowel disease who underwent a Malone antegrade continence enema procedure with or without concomitant urinary diversion. Materials and Methods: Consecutive adult patients with neurogenic bowel disease who underwent an antegrade continence enema procedure (continent catheterizable appendicocecostomy for fecal impaction) were retrospectively reviewed. Results: Of the 7 patients who underwent an antegrade continence enema synchronous urinary procedure (ileal conduit, augmentation ileocystoplasty with continent catheterizable abdominal stoma or augmentation ileocystoplasty) was also performed in 6. Mean patient age was 32 years and mean followup was 11 months. Of the 7 patients 6 who self-administered antegrade continence enemas regularly were continent of stool per rectum and appendicocecostomy, using the appendicocecostomy as the portal for antegrade enemas. All 6 compliant patients reported decreased toileting time and improved quality of life. Preoperative autonomic dysreflexia resolved postoperatively in 3 patients. All urinary tracts were stable. In 4 patients 5 complications occurred, including antegrade continence enema stomal stenosis requiring appendicocutaneous revision (1), antegrade continence enema stomal stenosis requiring dilation (1), superficial wound infection (1), small bowel obstruction requiring lysis of adhesions (1) and urinary incontinence (1 who underwent continent urinary diversion). Conclusions: Patients with neurogenic bladder and bowel disease may benefit from antegrade continence enema performed synchronously with a urinary procedure. Antegrade continence enema may be indicated alone for neurogenic bowel. Patient selection is important. References 1 : Management of Gastrointestinal, Genitourinary, and Sexual Function. In: Spinal Cord Injury: Clinical Outcomes from the Model Systems. Edited by . Gaithersburg, Maryland: Aspen Publishers1995: 122. Google Scholar 2 : Bowel dysfunction in spinal cord-injury patients. Lancet1996; 347: 1651. Google Scholar 3 : Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Amer. J. Gastroenterol.1990; 85: 1114. Google Scholar 4 : Comparison of the effectiveness of two bowel programs for CVA patients. Rehab. Nurs.1993; 18: 168. Google Scholar 5 : A comparison of the effectiveness of the Therevac SB and bisacodyl suppositories in SCI patients' bowel programs. Rehab. Nurs.1994; 19: 334. Google Scholar 6 : Management of bowel dysfunction in children with spinal cord disease or injury by means of the enema continence catheter. J. Ped.1992; 120: 190. Google Scholar 7 : Preliminary report: the antegrade continence enema. Lancet1990; 336: 1217. Google Scholar 8 : Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the antegrade continence enema procedure. Brit. J. Urol.1995; 75: 386. Google Scholar 9 : The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures. J. Urol.1996; 155: 1416. Link, Google Scholar 10 : The Malone antegrade continence enema for neurogenic and structural fecal incontinence and constipation. J. Urol.1995; 154: 759. Link, Google Scholar 11 : The Malone antegrade continence enema combined with urinary diversion in adult neurogenic patients: early results. Urology1997; 49: 963. Google Scholar 12 : Management of neurogenic fecal incontinence in myelodysplastic children by a modified continent appendiceal stoma and antegrade colonic enema. Urology1997; 49: 758. Google Scholar 13 : Large bowel transit in patients with paraplegia. Gut1984; 25: 1314. Google Scholar 14 : Constipation associated with chronic spinal cord injury: the effect of pelvic sympathetic stimulation by the Brindley stimulator. Paraplegia1991; 29: 463. Google Scholar 15 : Gastrointestinal complications of spinal cord injury. Spine1981; 6: 538. Google Scholar 16 : Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Amer. J. Gastroenterol.1990; 85: 1114. Google Scholar 17 : Autonomic hyperreflexia and its control in patients with spinal cord lesions. Ann. Intern. Med.1956; 44: 678. Google Scholar 18 : Autonomic dysreflexia. Top Spinal Cord Inj. Rehab.1997; 2: 54. Google Scholar 19 : The Malone antegrade continence enema. J. Ped. Surg.1995; 30: 68. Google Scholar 20 : The management of bowel problems in children with urological disease. Brit. J. Urol.1995; 76: 220. Google Scholar 21 : Combined Mitrofanoff and antegrade continence enema procedures for urinary and fecal incontinence. J. Urol.1997; 158: 192. Link, Google Scholar From the Division of Urology and Department of Rehabilitation Medicine, University of Texas Health Science Center and Spinal Cord Injury Unit, Audie L. Murphy Veterans' Affairs Medical Center, San Antonio, Texas© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBRUCE R, EL-GALLEY R, WELLS J and GALLOWAY N (2018) ANTEGRADE CONTINENCE ENEMA FOR THE TREATMENT OF FECAL INCONTINENCE IN ADULTS: USE OF GASTRIC TUBE FOR CATHETERIZABLE ACCESS TO THE DESCENDING COLONJournal of Urology, VOL. 161, NO. 6, (1813-1816), Online publication date: 1-Jun-1999. Volume 160Issue 4October 1998Page: 1278-1281 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information JOEL M.H. TEICHMAN More articles by this author J. MANSEL HARRIS More articles by this author DONALD M. CURRIE More articles by this author DOUGLAS B. BARBER More articles by this author Expand All Advertisement PDF downloadLoading ...