title: Outcomes following fecal continence procedures in patients with neurogenic bowel dysfunction.
abstract: OBJECTIVE
  Malone antegrade continence enema and cecostomy button improve quality of life in patients with neurogenic bowel. However, they have not been compared regarding fecal continence outcomes. We compared these 2 procedures with respect to continence, complications and conversions.
  
  
  METHODS
  We retrospectively reviewed the charts of patients who underwent Malone antegrade continence enema or cecostomy at the University of Alberta between January 2006 and January 2011. A total of 26 patients underwent Malone antegrade continence enema, of whom 20 underwent concomitant Monti procedure and bladder augmentation, 5 a laparoscopically assisted procedure and 1 concomitant ileovesicostomy. A total of 23 patients underwent cecostomy, of whom 1 underwent ileovesicostomy, 1 bladder augmentation, 1 a Monti procedure with bladder augmentation and 1 laparoscopic cecostomy. Continence was defined as ability to wear underwear with no accidents at most recent annual followup, which was a minimum of 1 year postoperatively.
  
  
  RESULTS
  Fecal continence rates were 84.6% for Malone antegrade continence enema and 91.3% for cecostomy. There were no statistically significant differences in continence based on procedure (p = 0.48), age (p = 0.97) or gender (p = 0.54). Of patients who underwent cecostomy 8.7% switched to the Malone antegrade continence enema, while 11.5% with Malone antegrade continence enema switched to cecostomy. Mean length of hospital stay for patients undergoing cecostomy vs laparoscopically assisted Malone antegrade continence enema was 4.0 vs 5.2 days (p = 0.15). Complications included stomal pain (23.1% of patients) and difficulty with catheterizing (19.2%) following Malone antegrade continence enema, and difficulty flushing (26.1%) following cecostomy.
  
  
  CONCLUSIONS
  There were no significant differences between Malone antegrade continence enema and cecostomy button with respect to fecal continence or complication rates. Each approach poses unique challenges, suggesting that patients and families need to understand the differences to make an individualized choice.
authors.affiliation: Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nathan Y
authors.initials: NY
authors.lastname: Hoy
authors.forename: Peter
authors.initials: P
authors.lastname: Metcalfe
authors.forename: Darcie A
authors.initials: DA
authors.lastname: Kiddoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002431:Cecostomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055496:Neurogenic Bowel / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult