Transanal irrigation for the treatment of neuropathic bowel dysfunction.
BACKGROUND
Children with spinal cord lesions very often experience bowel dysfunction, with a significant impact on their social activities and quality of life. Our aim was to evaluate the efficacy of the Peristeen transanal irrigation (TI) system in patients with neuropathic bowel dysfunction (NBD).


METHODS
We prospectively reviewed 40 children with spina bifida and NBD who did not respond satisfactorily to conventional bowel management and were treated with the Peristeen TI system. Dysfunctional bowel symptoms, patient opinion and level of satisfaction were analysed before and during TI treatment using a specific questionnaire.


RESULTS
Thirty-five children completed the study. Mean patient age and follow up were 12.5 years (6-25) and 12 months (4-18), respectively. Average irrigation frequency and instillation volume were once every 3 days and 616ml (200-1000), respectively. Bowel dysfunction symptoms including faecal incontinence improved significantly in all children. Patient opinion of intestinal functionality improved from 2.3±1.4 to 8.2±1.5 (P<0.0001) and mean grade of satisfaction with the Peristeen system was 7.3. Patient independence also improved from 28 to 46% and no adverse events were recorded.


CONCLUSIONS
TI should be used as a first therapeutic approach in those children with NBD who do not respond to conservative or medical bowel management before other more invasive treatment modalities are considered. The Peristeen system is as effective as other TI methods, but it is easy to learn, safe and increases the patient's independence.
López Pereira
Pedro
P
Department of Paediatric Urology, University Hospital "La Paz", P° de la Castellana 261, Madrid-28046, Spain. plpuro@hotmail.com
Salvador
Obdulia Perez
OP
Arcas
Julia Alonso
JA
Martínez Urrutia
M A Jose
MA
Romera
Roberto Lobato
RL
Monereo
Enrique Jaureguízar
EJ
D000293:Adolescent; D000328:Adult; D002648:Child; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D007507:Therapeutic Irrigation / Q000379:methods*; D055815:Young Adult