TREATMENT OF NEUROPATHIC URINARY AND FECAL INCONTINENCE WITH SYNCHRONOUS BLADDER RECONSTRUCTION AND THE ANTEGRADE CONTINENCE ENEMA PROCEDURE

Objectives To report our experience with synchronous bladder reconstru ction and the antegrade continence enema (ACE) procedure in the manage ment of neuropathic urinary and faecal incontinence. Patients and meth ods Eight patients (four boys, four girls) with a median age of 9 pear s 10 months (range 4.5-17) were treated. Five had spina bifida, two hi gh ano-rectal malformations and one had been successfully treated for a spinal neuroblastoma. The appendix was used for the ACE procedure in five patients and a tubularized caecal or colonic nap in the other th ree. Seven patients had an augmentation cystoplasty and one a cystecto my with a continent diversion. A bladder neck reconstruction or an ure thral lengthening procedure was performed in five patients and the bla dder outlet was closed in two. Six patients required some form of revi sion, Four patients underwent a simultaneous Mitrofanoff procedure. Re sults The median length of follow-up was 11.5 months (range 3-29), Fiv e patients were completely clean and the remaining three experienced m inor faecal soiling only, They were all delighted with the result, Six patients were dry day and night, one was wet at night only while the final patient was wet day and night. Conclusions Synchronous surgical procedures to make patients with neuropathic incontinence both clean a nd dry is effective, but most patients require revision surgery. Patie nt motivation and selection and the availability of a nurse specialist is crucial in obtaining satisfactory results.