Mo. Bau et al., The Malone antegrade colonic enema isolated or associated with urological incontinence procedures: Evaluation from patient point of view, J UROL, 165(6), 2001, pp. 2399-2403
Purpose: Fecal and urinary incontinence in patients with congenital or acqu
ired spinal cord defects represents a handicap that impairs chances of inte
gration in society. Associated with the management of urinary incontinence,
the Malone antegrade colonic enema is a generally successful procedure for
resolving refractory fecal incontinence. We report the results of the eval
uation of this technique from the patient perspective.
Materials and Methods: A survey was conducted among 19 patients who had und
ergone a Malone procedure, combined in 14 with urological surgical interven
tion for urinary incontinence. Patients completed a questionnaire either by
mail or during an interview with a urotherapy nurse and/or a psychologist.
Questions concerned patient opinion about the quality of preoperative info
rmation, perioperative period, stoma, functional result and overall satisfa
ction. The psychological impact of the procedure was also evaluated during
the interviews. No complication occurred related to the Malone procedure or
stomal stenosis, and a perfect functional result was achieved in 17 patien
ts, 1 of whom had occasional leakage through the stoma.
Results: Of the 19 patients in the study 2 who have abandoned using the Mal
one procedure, including 1 with a poor result and 1 with a good functional
result, did not return the questionnaire. The remaining 17 patients believe
d they had received adequate preoperative information and expressed no spec
ific complaint about the perioperative period. The 15 with the stoma in the
umbilicus were satisfied, although 3 young patients were temporarily distu
rbed by catheterizing the umbilicus and 2 with the stoma in the right fossa
iliaca were disappointed. The 15 patients who had a perfect functional res
ult recognized great improvement in quality of life but 13 complained of pa
in (12) and/or excessive duration of the procedure (9). The patient with a
poor functional result and the other with occasional stomal leakage would n
ot consider the procedure again. These 2 patients had durable postoperative
depression while 3 others who ultimately achieved a good functional result
experienced temporary depression.
Conclusions: The Malone procedure generally meets the expectations of patie
nts but it is considered by a majority as painful and lengthy. The umbilicu
s is the preferred stoma site but may prove to be disturbing in young patie
nts. Abandonment of the procedure and postoperative depression experienced
by some patients, despite a good functional result, deserve better preventi
on.