[Survey on satisfaction of patients with Malone continent cecostomy]

A questionnaire to assess their level of satisfaction was sent to 28 patients who underwent a continent cecostomy for antegrade enema (Malone procedure).

All the patients presented with neurogenic bladder and a severe constipation due to spina bifida in 21 cases, anorectal malformation in 4, cloacal malformation in 1, sacral agenesis in 1 and post-myelitis paraplegia in 1. The mean age at surgery was 15 years. The mean follow-up is 3 years and 8 months. Surgery on the bladder was done in 18 patients of which 10 at the same stage. Urinary continence between bladder catheterizations occurred in 5 patients with isolated cecostomy.

24 patients answered the questionnaire. Among the remaining 4, 1 has a too short follow-up, 1 refused the enemas and his cecostomy definitely closed and 2, when seen at clinics, have an excellent result. Enemas are done twice a week, they last on average one hour with an average of 3 litres of liquid, usually tap water. All the 24 patients consider to have benefited from the operation mainly regarding their personal, family and social wellbeing. All have acquired anal continence, only 3 have some soiling between enemas. The main reported drawbacks concern pain at passing of stools (14 cases) well improved by addition of Colopeg in the enema, fatigue (21 cases) or headache (5 cases) after enemas. These troubles, probably due to a temporary hyponatremia, are well improved by addition of table salt in the water.

This enquiry established the high degree of satisfaction given by the Malone procedure in the treatment of severe constipation frequently associated with a congenital neurogenic bladder. Despite some drawbacks this solution must be considered in such situation.