title: The value of the MACE (Malone antegrade colonic enema) procedure in adult patients.
abstract: BACKGROUND
  We report our experience with the Malone antegrade colonic enema (MACE) procedure in adult patients suffering from urinary incontinence and intractable constipation with or without fecal soiling.
  
  
  METHODS
  Since June 1990, the MACE procedure was initiated in 4 female and 12 male patients 14-54 years old (mean age, 29.9 years) with different pathologic conditions (myelodysplasia, n = 7; anorectal anomaly, n = 3; spinal cord lesion, n = 4; neuropathic disease of unclear cause, n = 2). Three surgical techniques were used: reversed and in situ appendix and tapered ileum). Complex simultaneous urologic continence procedures were performed in nine patients. Two patients had undergone previous operations in the lower urinary tract.
  
  
  RESULTS
  After 6.6 years of followup (average, 41.7 months), eight patients (50%) were still using the MACE successfully. They were completely clean day and night and were relieved of symptoms of constipation. Eleven complications related to the MACE procedure occurred in seven patients (44%). Eight patients abandoned the procedure for various reasons. The failure rate was higher in chronically constipated patients without fecal soiling.
  
  
  CONCLUSIONS
  The MACE procedure is associated with a high failure rate when used in adults, but it may be possible to identify a subgroup of patients in whom the procedure could be beneficial. Success would depend on overcoming technical problems and difficulties with patient compliance.
authors.affiliation: Institute of Urology and Nephrology, University College London Medical School, England.
authors.forename: E W
authors.initials: EW
authors.lastname: Gerharz
authors.forename: V
authors.initials: V
authors.lastname: Vik
authors.forename: G
authors.initials: G
authors.lastname: Webb
authors.forename: R
authors.initials: R
authors.lastname: Leaver
authors.forename: P J
authors.initials: PJ
authors.lastname: Shah
authors.forename: C R
authors.initials: CR
authors.lastname: Woodhouse
mesh_terms: D000293:Adolescent; D000328:Adult; D002431:Cecostomy / Q000009:adverse effects / Q000706:statistics & numerical data; D003106:Colon; D003131:Combined Modality Therapy; D003248:Constipation / Q000628:therapy; D004733:Enema / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D017211:Treatment Failure; D014549:Urinary Incontinence / Q000628:therapy