THE VALUE OF THE MACE (MALONE ANTEGRADE COLONIC ENEMA) PROCEDURE IN ADULT PATIENTS

Background: We report our experience with the Malone antegrade colonic enema (MACE) procedure in adult patients suffering from urinary incon tinence and intractable constipation with or without fecal soiling. St udy Design: Since June 1990, the MACE procedure was initiated in 4 fem ale and 12 male patients 14-54 years old (mean age, 29.9 years) with d ifferent pathologic conditions (myelodysplasia, n = 7; anorectal anoma ly, n = 3; spinal cord lesion, n = 4; neuropathic disease of unclear c ause, n = 2). Three surgical techniques were used: reversed and in sit u appendix and tapered ileum). Complex simultaneous urologic continenc e procedures were performed in nine patients. Two patients had undergo ne previous operations in the lower urinary tract. Results: After 6.6 years of followup (average, 41.7 months), eight patients (50%) were st ill using the MACE successfully. They were completely clean day and ni ght and were relieved of symptoms of constipation. Eleven complication s related to the MACE procedure occurred in seven patients (44%). Eigh t patients abandoned the procedure for various reasons. The failure ra te was higher in chronically constipated patients without fecal soilin g. Conclusions: The MACE procedure is associated with a high failure r ate when used in adults, but it may be possible to identify a subgroup of patients in whom the procedure could be beneficial. Success would depend on overcoming technical problems and difficulties with patient compliance. (C) 1997 by the American College of Surgeons.