title: The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures.
abstract: OBJECTIVE
  Functional alterations of the gastrointestinal and genitourinary tracts, and physical limitations in children with spina bifida, imperforate anus and spinal cord injury challenge the ability to have independent fecal and urinary continence. Urologists have successfully helped these patients achieve urinary continence. We report our experience with the antegrade colonic enema procedure, which allows select individuals to achieve continence of stool, enhancing quality of life.
  
  
  METHODS
  Since December 1992, 18 antegrade colonic enema procedures were performed in 12 female and 6 male patients 5 to 31 years old of whom 14 had spina bifida, 2 had imperforate anus and 2 had spinal cord injury. Simultaneous urological continence procedures were performed in 8 patients, including appendicovesicostomy in 4, augmentation cystoplasty in 2 and augmentation cystoplasty plus an ileal Mitrofanoff procedure in 2. Four patients previously underwent urological reconstruction.
  
  
  RESULTS
  In 24 months of followup (average 6.6) all patients with a functioning stoma remained continent of stool and 17 were continent of urine. Complications related to the antegrade colonic enema procedure occurred in 4 children (22%) of whom 3 required further surgery. Three patients (17%) had minor stomal stenosis.
  
  
  CONCLUSIONS
  The antegrade colonic enema procedure is easily performed and it should be considered for any child with significant physical limitations and/or refractory fecal incontinence before urological continence promoting procedures are done.
authors.affiliation: Division of Urology, University of Florida, Jacksonville, Florida, USA.
authors.forename: P I
authors.initials: PI
authors.lastname: Ellsworth
authors.forename: H W
authors.initials: HW
authors.lastname: Webb
authors.forename: J M
authors.initials: JM
authors.lastname: Crump
authors.forename: M A
authors.initials: MA
authors.lastname: Barraza
authors.forename: P S
authors.initials: PS
authors.lastname: Stevens
authors.forename: H G
authors.initials: HG
authors.lastname: Mesrobian
mesh_terms: D000293:Adolescent; D000328:Adult; D001006:Anus, Imperforate / Q000150:complications; D002431:Cecostomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications; D016135:Spinal Dysraphism / Q000150:complications; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*