title: Experience with glycerin for antegrade continence enema in patients with neurogenic bowel.
abstract: OBJECTIVE
  Malone antegrade continence enemas are used in the management of neurogenic bowel to attain fecal continence. Several different irrigation solutions have been described but glycerin, an osmotic laxative that promotes peristalsis, has rarely been mentioned or studied. We assessed clinical outcomes in our patients with a Malone antegrade continence enema using glycerin based irrigation.
  
  
  METHODS
  We retrospectively reviewed patients with neurogenic bowel who underwent a Malone antegrade continence enema procedure between 1997 and 2011. Glycerin diluted with tap water followed by a tap water flush is our preferred irrigation protocol. Bowel regimen outcomes examined included fecal continence, emptying time, leakage from stoma, enema volume, frequency and independence.
  
  
  RESULTS
  Of the 23 patients with followup greater than 6 months 19 used glycerin based irrigation. Average age at surgery was 8.8 years. Patients using glycerin instilled a median of 30 ml (mean 29) glycerin and 50 ml (131) tap water. Fecal continence rate was 95% and stoma leakage rate was 16%, and only 16% of patients required daily irrigation.
  
  
  CONCLUSIONS
  Glycerin is a viable and effective alternative irrigant for antegrade enemas of neurogenic bowel, with an excellent fecal continence rate. The volume of irrigant needed is typically less than 90 ml, which is much less than in published reports using tap water alone.
authors.affiliation: Section of Pediatric Urology, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Chu
authors.forename: Zarine R
authors.initials: ZR
authors.lastname: Balsara
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.forename: Sherry S
authors.initials: SS
authors.lastname: Ross
authors.forename: John S
authors.initials: JS
authors.lastname: Wiener
mesh_terms: D002648:Child; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D005990:Glycerol / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D055496:Neurogenic Bowel / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D005990:Glycerol