The Malone antegrade colonic enema isolated or associated with urological incontinence procedures: Evaluation from patient point of view

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.