Treatment of neuropathic urinary and faecal incontinence

Area of Science:

• Pediatric Surgery
• Urology
• Gastroenterology

Background:

• Children with meningomyelocoele often experience fecal and urinary incontinence, significantly impacting their quality of life.
• The Malone Antegrade Continence Enema (MACE) procedure is a surgical option to manage these complex continence issues.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the MACE procedure in children with meningomyelocoele and incontinence.
• To assess the impact of MACE, with or without concurrent bladder augmentation, on continence and independence.

Main Methods:

• Retrospective review of 14 children (aged 6-17 years) who underwent the MACE procedure after meningomyelocoele repair.
• MACE was performed with synchronous Mitrofanoff stoma creation in one child and simultaneous bladder augmentation (colocystoplasty, ileocystoplasty, or ureterocystoplasty) in 10 patients.
• Follow-up ranged from six months to two years.

Main Results:

• All 14 patients achieved fecal and urinary continence ('clean and dry').
• Three children experienced MACE stoma stenosis, with one requiring revision.
• The procedure led to significant improvements in patients' quality of life and independence.

Conclusions:

• The MACE procedure, including variations with bladder augmentation, is a highly effective treatment for fecal and urinary incontinence in children with meningomyelocoele.
• Despite potential stoma complications, the MACE procedure offers substantial benefits for patient independence and overall well-being.