title: Long-term results for Malone antegrade continence enema for adults with neurogenic bowel disease.
abstract: OBJECTIVE
  To determine the long-term outcomes from the Malone antegrade continence enema (ACE) procedure in adult neurogenic patients.
  
  
  METHODS
  A retrospective review of adult patients who underwent the ACE procedure for neurogenic bowel was done. Patients were studied if they had follow-up of greater than 4 years. We compared pre-ACE and post-ACE toileting times, bowel continence status, and complications, and elicited patient subjective satisfaction with their quality of life.
  
  
  RESULTS
  Six patients were available for study. Mean age was 35 years with a mean follow-up of 4.5 years. Urinary diversion was done in 5 patients. Pre-ACE toileting time was 190 +/- 45 minutes versus post-ACE toileting time of 28 +/- 20 minutes (P <0.001). Four of six patients pre-ACE were incontinent of stool per rectum compared with 1 of these 4 patients post-ACE (P = 0.03). Five patients were continent of stool per ACE stoma. Four patients (67%) had complications. Three of five patients (60%) who underwent synchronous urinary diversion required postoperative re-exploration. Five patients (83%) were satisfied with their outcome and rated their quality of life higher after the ACE procedure compared with pre-ACE.
  
  
  CONCLUSIONS
  The ACE procedure is effective in the long-term management of adult neurogenic bowel. The complication and re-exploration rates are high. Patients must be properly selected to determine appropriate motivation.
authors.affiliation: Division of Urology, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
authors.forename: Joel M H
authors.initials: JM
authors.lastname: Teichman
authors.forename: Nasim
authors.initials: N
authors.lastname: Zabihi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kraus
authors.forename: J Mansel
authors.initials: JM
authors.lastname: Harris
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Barber
mesh_terms: D000328:Adult; D001065:Appendix / Q000601:surgery; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002431:Cecostomy; D003248:Constipation / Q000601:surgery / Q000628:therapy*; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures; D004733:Enema / Q000379:methods*; D005244:Fecal Impaction / Q000601:surgery; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007422:Intestines / Q000294:innervation; D008297:Male; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D054047:Surgical Stomas; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods