THE MALONE ANTEGRADE COLONIC ENEMA ENHANCES THE QUALITY-OF-LIFE IN CHILDREN UNDERGOING UROLOGICAL INCONTINENCE PROCEDURES

Purpose: Functional alterations of the gastrointestinal and genitourin ary tracts, and physical limitations in children with spina bifida, im perforate anus and spinal cord injury challenge the ability to have in dependent fecal and urinary continence. Urologists have successfully h elped these patients achieve urinary continence. We report our experie nce with the antegrade colonic enema procedure, which allows select in dividuals to achieve continence of stool, enhancing quality of life. M aterials and Methods: Since December 1992, 18 antegrade colonic enema procedures were performed in 12 female and 6 male patients 5 to 31 yea rs old of whom 14 had spina bifida, 2 had imperforate anus and 2 had s pinal cord injury. Simultaneous urological continence procedures were performed in 8 patients, including appendicovesicostomy in 4, augmenta tion cystoplasty in 2 and augmentation cystoplasty plus an ileal Mitro fanoff procedure in 2. Four patients previously underwent urological r econstruction. Results: In 24 months of followup (average 6.6) all pat ients with a functioning stoma remained continent of stool and 17 were continent of urine. Complications related to the antegrade colonic en ema procedure occurred in 4 children (22%) of whom 3 required further surgery, Three patients (17%) had minor stomal stenosis. Conclusions: The antegrade colonic enema procedure is easily performed and it shoul d be considered for any child with significant physical limitations an d/or refractory fecal incontinence before urological continence promot ing procedures are done.