title: The malone antegrade continence enema combined with urinary diversion in adult neurogenic patients: early results.
abstract: OBJECTIVE
  Patients with neurogenic voiding dysfunction often have coexisting neurogenic bowel problems. Impaired bowel evacuation is a cause of major morbidity and impaired lifestyle for these patients. The Malone antegrade continence enema (ACE) performed synchronously with a urinary continence procedure has been successful in pediatric patients. We report early experience combining the ACE with a urinary continence procedure in adult neurogenic patients.
  
  
  METHODS
  Adult patients with neurogenic voiding dysfunction and impaired bowel evacuation refractory to conservative management underwent a urinary continence procedure synchronously with an ACE.
  
  
  RESULTS
  Two patients have undergone the procedure. One patient chose a continent catheterizable supravesical bladder augmentation, whereas the other patient chose an ileal conduit. Both patients had a separate appendiceal stoma for their ACE. Both patients are continent of stool at their appendiceal stoma and per rectum. Both patients have stabilized their urinary tracts. Complications were minimal.
  
  
  CONCLUSIONS
  The ACE may benefit adult patients with impaired bowel evacuation and may be combined with a urinary continence procedure. Further study of the ACE is warranted.
authors.affiliation: Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio 78284-7845, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Teichman
authors.forename: V J
authors.initials: VJ
authors.lastname: Rogenes
authors.forename: D B
authors.initials: DB
authors.lastname: Barber
mesh_terms: D000328:Adult; D001065:Appendix / Q000601:surgery; D002432:Cecum / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D013119:Spinal Cord Injuries / Q000150:complications; D013514:Surgical Procedures, Operative / Q000379:methods; D014547:Urinary Diversion; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*