FI: nm Constipation: nm - better rectal sensation - ability to hold consciously 30min/d, 5 d/w (improvement of any parameter) 71% complete bowel continence No adverse effects Han et al, 04 25 n= 24 SB Age: 4-13y LL: nm FI: nm Constipation: nm FU: 15.8 months TT: nm No stool loss Single centre Retrospective case review Daily 1h at home transurethral ES, 5days/w for 4w FU cycles: 2w every 3 to 6mo One week diary before treatment and subsequent cycles Mean episodes of faecal incontinence decreased significant from 7.3 to 4.8 a week (p<0.05) Complete faecal continence in 50% (12/24) Urinary tract infections in 10 patients during transurethral ES Not evaluated Kajbafzadeh et al, 12 26 n= 30 SB Age: 3-12y LL: nm FI: nm Constipation: nm FU: nm TT: nm Stool loss < 1x/ week Single centre Randomized controlled trial Home cutaneous ES for 20 min, 3x/w: 15 treatment, 15 sham Bowel habit diary, NBD: range (47= severe bowel dysfunction)45 Manometry before and 6mo after treatment Constipation is decreased in 11/15 (73%) and remained in 8/15 (53%) after 6mo Significant increase of stool frequency from 2.5 to 4.7 stools/w after treatment Significant improvement manometry measures No adverse effects Not evaluated Legend: ES: electrical stimulation, SB: spina bifida, FU: follow up, NBD: neurogenic bowel dysfunction Table 3: Summary of papers on non conservative bowel management in spina bifida patients Author Sample Follow up/ defecation time Definition faecal continence Study design Findings - effectiveness Findings - complications Findings - satisfaction Hensle et al, 97 27 N= 27 SB Age: 10-31y 22 wheelchair FU: 9-30 months TT: 30 min Not defined Single centre Retrospective case review Malone ACE, 8 concomitant 2 dropped out 19/25 (76%): complete bowel control 25/27 reported substantial improvement in their QoL
LL: nm FI: nm Constipation: nm [15-180] water Questionnaire: 32 responded from 51 still using ACE 22/62 redo surgery continence and satisfaction (p=.04) Casale et al, 06 33 N= 275 SB Age: mean 11y LL: nm FI: nm Constipation: nm FU: 45-120 months TT: nm Not defined Single centre Retrospective chart review 215 Malone ACE Single surgery compared to combined urologic surgery (n=158) 94% continence, no difference between groups 27% complications, no difference between groups Not evaluated Lemelle et al, 06 34 N= 423 SB Age: 10-47y 145 wheelchair LL: nm FI: nm Constipation: nm FU: 36 months TT: 50min [15-90] 5 point Likert scale (1=permanent, 2=frequent, 3=occasional, 4=rare, 5=never) Multicentre Clinical interview and medical chart review Right ACE: 40, left ACE: 7, 1.2L tap or saline water Conventional treated group (n=382) compared to ACE group (n=41) 6 dropped out ACE group is significant younger ACE group significant less FI Left ACE tends to shorter defecation time and worse FI Not evaluated Bani-Hani et al, 08 35 N= 236, 199 SB Age: 2-36y LL: nm FI: nm Constipation: nm FU: 50 months TT: nm No stool loss Single centre Retrospective chart review Malone ACE daily 642ml tap water Evaluation of use of additives: - immediate FI: larger volume or more time on toilet - midday FI: bowel cleanout and add 17mg MiraLAX 196/236 (83%) continence rose to 221/236 (94%) using additives Not evaluated Cain et al, 08 36 N= 236, 199 SB Age: 2-36y LL: nm FI: nm Constipation: nm FU: 50 months TT: nm No stool loss Single centre Retrospective chart review Malone ACE daily, 642ml tap water 221/236 (94%) continent 98/236 complications 51/236 redo surgery Not evaluated
Wong et al, 08 37 N= 64, 41 SB Age: 6-15y LL: nm FI: nm Constipation: nm FU: nm TT: 5-60min No stool loss Single centre Retrospective chart review Interviews and telephone, structured questionnaire score 0-24 (0=full continence, 24= complete incontinence) Chait cecostomy glycerine or saline water every 48 to 72h FI score in SB improved from 18 to 7 28/64 complications Not evaluated Yardley et al, 09 38 N= 61,27 SB Age: LL: nm FI: nm Constipation: nm FU: 132 months TT: nm Stool loss < 1x/ month Single centre Postal/telephone questionnaire 25 dropped out 11/16 (69%) SB continent 5/36 complications 2/36 redo surgery Satisfaction score of ACE users: 4 (1=very unsatisfied, 5= very satisfied) High dissatisfaction with transitional care Matsuno et al, 10 39 N= 25 SB Age: 5 wheelchair LL: nm FI: nm Constipation: nm FU: 27.5 months TT: 37.7 min [20-60] No stool loss Single centre Comparing RCE to ACE retrospectively - 13 patients RCE - 12 patients ACE tap water, daily to every 48h age is significant (p=0.009) younger in RCE compared to ACE 10/13 (77%) RCE 8/12 (75%) ACE 3/13 RCE independent 8/12 ACE independent Not evaluated Bar-Yosef et al, 11 40 N= 21 SB Age: 6-22y LL: nm FI: nm Constipation: nm FU: 56 months TT: nm Not defined Single centre Retrospective chart review Artificial urinary sphincter and Malone ACE 19/21 (90%) full fecal continence 3/21 complications 2/21 redo surgery Not evaluated Ok and Kurzrock, 11 41 N= 23 SB families Age: nm LL: nm FI: nm Constipation: FU: 6 months TT: 45 min Not defined Single centre FICQoL: 51 item questionnaire before and 6 months after ACE procedure - 23 families before surgery - 18 families after surgery Diaper need decreased Accident number improved from 3.9 to 0.3 per week (p<0.01) Significant improvement in caretaker anxiety, depression and bother