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Combined Mitrofanoff and antegrade continence enema procedures for urinary and fecal incontinence
1Department of Urology, Great Ormond Street Hospital, London, United Kingdom.
Insights
This study shows that combining Mitrofanoff and antegrade continence enema channels effectively treats double incontinence in children. Patient motivation is key for successful outcomes in managing urinary and fecal issues.
Area of Science:
- Pediatric Urology
- Colorectal Surgery
- Reconstructive Surgery
Background:
- Fecal soiling and constipation are common in children with urinary incontinence undergoing reconstructive urological surgery.
- Double incontinence (urinary and fecal) presents significant challenges in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of synchronous construction of Mitrofanoff conduits and antegrade continence enema (ACE) channels for treating double incontinence in children.
- To review the surgical techniques and outcomes associated with these combined procedures.
Main Methods:
- Eighteen pediatric patients (ages 2-18) with underlying conditions like spinal lesions, bladder exstrophy, or cloacal anomalies underwent simultaneous Mitrofanoff and ACE channel creation.
- The appendix, cecal flap, or ileum were utilized for ACE channels, while the appendix, ureter, ileum, or detrusor tube formed Mitrofanoff channels.
- Stoma construction employed V-flap or V. Z. Q. techniques, with stomas placed in close proximity in the right lower quadrant.
Main Results:
- Fifteen of 18 patients achieved dryness with regular clean intermittent catheterization (CIC) and satisfactory fecal continence.
- Minor revisions for catheterization difficulties were needed in 10 patients.
- Three patients required repeat operations for channel reconstruction, and two channels closed due to non-compliance or severe constipation.
Conclusions:
- Synchronous creation of ACE and Mitrofanoff channels is a successful strategy for managing double incontinence in pediatric patients.
- Careful patient selection, emphasizing high motivation, is crucial for achieving optimal and lasting results.
Purpose:
Fecal soiling or intractable constipation frequently occurs in association with urinary incontinence in children undergoing major reconstructive urological operations. To treat double incontinence or the combination of wetting and severe constipation, we constructed a Mitrofanoff conduit and a channel for antegrade continence enemas in 18 patients between 1989 and 1995. We review the underlying pathological conditions, various surgical techniques and outcomes of these operations.
Materials And Methods:
Underlying abnormalities mainly included spinal lesions, bladder exstrophy, imperforate anus and various cloacal anomalies. Patient age ranged from 2 to 18 years (average 8.4). In 13 patients both procedures were done simultaneously. The appendix was used to construct the antegrade continence enema channel in 8 cases and the Mitrofanoff channel in 5. It was long enough to be divided and used for both procedures in 2 cases but it was missing or unsuitable in 3. Alternative antegrade continence enema conduits were cecal flap in 7 patients and ileum in 1, while the ureter, ileum and detrusor tube were used to establish Mitrofanoff channels in 5, 5 and 1, respectively. Stomas were constructed according to the V-flap or V. Z. Q. technique and situated in close proximity in the right lower abdominal quadrant in 13 cases.
Results:
Convalescence was uneventful except for 1 abscess near an antegrade continence enema stoma. Ten patients needed dilation or minor revisions due to difficulty in catheterizing the antegrade continence enema (5), Mitrofanoff (3) or both conduits (2). Subsequently 3 patients underwent repeat operations for reconstruction of 2 antegrade continence enema channels (cecal flap and ileum) and 1 detrusor tube Mitrofanoff channel. Currently 15 patients are dry on regular clean intermittent catheterization using 10 to 12F catheters. Outcomes of the antegrade continence enema channels are satisfactory in 15 patients who are clean or rarely soil. Failure occurred in 1 patients with severe constipation necessitating colostomy and 2 (1 noncompliant who stopped catheterizing regularly) in whom the channels subsequently closed.
Conclusions:
Synchronous construction of antegrade continence enema and Mitrofanoff channels is successful in the majority of doubly incontinent patients. Selection of patients with high motivation is important to obtain satisfactory results.