ROLE OF THE ANTEGRADE CONTINENCE ENEMA IN THE MANAGEMENT OF THE MOST DEBILITATING CHILDHOOD RECTO-UROGENITAL ANOMALIES

Purpose: We evaluated the antegrade continence enema for managing the most severely compromised fecal continence mechanisms and the efficacy of nonappendiceal conduits in children when appendix is unavailable. Materials and Methods: Ten patients 3 to 25 years old underwent contin ent cecostomy for the purpose of the antegrade continence enema. Diagn oses included the VATER association in 4 cases, myelomeningocele in 3, cloacal anomaly in 2 and isolated imperforate anus in 1. Eight patien ts received a tubularized ileal conduit, 2 received an appendiceal con duit and 2 underwent concomitant fecal undiversion. Results: Followup ranged from 4 to 28 months (mean 17.6). All patients have achieved exc ellent fecal continence and no significant stomal soilage or difficult y with catheterization has been noted. Patients reported a high degree of satisfaction. Conclusions: Continent cecostomy for the antegrade c ontinence enema is highly effective even in the presence of severe str uctural anorectal disease. The tapered ileal conduit is an excellent a lternative to the appendiceal conduit.