title: Retrograde continence enema in children with spina bifida: Not as effective as first thought.
abstract: OBJECTIVE
  The aim of the study is to investigate the effectiveness of Peristeen retrograde continence enema (RCE) in the management of faecal incontinence in children with spina bifida.
  
  
  METHODS
  We identified a homogenous group of spina bifida patients in whom RCE was initiated (Jan 2006-July 2013). Confidential assessments included (i) Fecal Incontinence Quality Of Life (FIQOL), (ii) St Marks Faecal Incontinence score, (iii) Cleveland Clinic Constipation score and (iv) Neurogenic Bowel Dysfunction score.
  
  
  RESULTS
  Of 20 patients, 11 (mean age 14.5 ± 5.3 years) were male. Of 20 patients, nine were still using RCE (mean follow-up 4.1 years). Three patients ceased RCE within 10 days, six after 4-12 months and two after 36-48 months. Reasons for cessation included balloon difficulties (n = 4), procedure deemed too difficult (n = 4) and pain (n = 3). There were no differences between the groups in length of training time for technique, instillate fluid/volume used and time taken to perform RCE. There were no differences between the groups for quality of life, faecal incontinence or constipation scores.
  
  
  CONCLUSIONS
  We demonstrated a high rate of cessation with RCE in patients with spina bifida. This could not be explained by associated conditions, or by enema-related parameters. One possible explanation is the lack of ongoing outpatient support for the children and their families.
authors.affiliation: Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.|Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sebastian K
authors.initials: SK
authors.lastname: King
authors.affiliation: Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Lefteris
authors.initials: L
authors.lastname: Stathopoulos
authors.affiliation: Department of Stoma Therapy, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Loreto
authors.initials: L
authors.lastname: Pinnuck
authors.affiliation: Department of Stoma Therapy, and, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Wells
authors.affiliation: Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.|Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Hutson
authors.affiliation: Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Yves
authors.initials: Y
authors.lastname: Heloury
mesh_terms: D000293:Adolescent; D005242:Fecal Incontinence / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D011788:Quality of Life; D016135:Spinal Dysraphism / Q000150:complications*; D055815:Young Adult
keywords: Peristeen; faecal incontinence; retrograde continence enema; spina bifida