Medical and surgical management of neurogenic bowel

Gor, Ronak A.; Katorski, Jenna; Elliott, Sean P.

doi:10.1097/mou.0000000000000299

Cited by 32 publications

(18 citation statements)

References 75 publications

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“…Individuals with SCI frequently experience neurogenic bowel dysfunction, which may be characterized by stool retention, constipation, and fecal incontinence [3]. In addition to adversely affecting patient quality-of-life [4,5] and being an enormous burden on the healthcare system [6], neurogenic bowel dysfunction can lead to a host of life-threatening sequelae such as intestinal obstruction, recurrent urinary tract infections from chronic constipation, and hemorrhoidal disease [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…To limit the harmful effects of these potentially disastrous consequences, clinicians have developed several management modalities for SCI patients with bowel dysfunction, ranging from conservative (targeting diet and bowel habits) to invasive (e.g. sacral anterior root stimulation and permanent colostomy) [8,9]. Despite these strategies, there is no definitive cure for neurogenic bowel dysfunction, making it a chronic, life-altering condition.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

2020

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Study design Retrospective analysis of prospectively collected data. Objectives Recently, logistic regression models were developed to predict independence in bowel function 1 year after spinal cord injury (SCI) on a multicenter European SCI (EMSCI) dataset. Here, we evaluated the external validity of these models against a prospectively accrued North American SCI dataset. Setting Twenty-five SCI centers in the United States and Canada. Methods Two logistic regression models developed by the EMSCI group were applied to data for 277 patients derived from three prospective multicenter SCI studies based in North America. External validation was evaluated for both models by assessing their discrimination, calibration, and clinical utility. Discrimination and calibration were assessed using ROC curves and calibration curves, respectively, while clinical utility was assessed using decision curve analysis. Results The simplified logistic regression model, which used baseline total motor score as the predictor, demonstrated the best performance, with an area under the ROC curve of 0.869 (95% confidence interval: 0.826–0.911), a sensitivity of 75.5%, and a specificity of 88.5%. Moreover, the model was well calibrated across the full range of observed probabilities and displayed superior clinical benefit on the decision curve. Conclusions A logistic regression model using baseline total motor score as a predictor of independent bowel function 1 year after SCI was successfully validated against an external dataset. These findings provide evidence supporting the use of this model to enhance the care for individuals with SCI.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

2020

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“…In the past, this goal has often only been achieved by resorting to surgical procedures such as the Malone ACE, or even ostomy. Such traditional surgical continence procedures can indeed be highly effective in carefully selected patient groups [155], but they carry a relatively high risk of surgical complications and an increased risk of anesthesiology procedures. The advent of TAI changed traditional bowel management for the significant numbers who do not respond to conservative and pharmacological approaches alone, permitting successful treatment of a large population of pediatric and adolescent patients with NBD, without requiring surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical approach for NBD in children primarily involves creating artificial "upstream" access for antegrade administration of colonic irrigation enemas, either by Malone's antegrade continence enema (ACE) procedure, or by tube cecostomy. This might be especially advantageous in patients with stool impaction due to NBD [155] or in those who, due to comorbidities, lack the balance, manual dexterity, or motivation to self-administer retrograde washouts by TAI [13]. Many teenagers can administer their antegrade enemas independently via an intermittently inserted catheter or an indwelling tube.…”

Section: Bowel Surgerymentioning

confidence: 99%

Neurogenic Bowel Dysfunction in Children and Adolescents

Mosiello

Safder

Marshall

et al. 2021

JCM

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Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.

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“…The antegrade colonic enema (ACE), originally described by Malone et al, 1 has been shown to be effective in the management of fecal incontinence and chronic constipation in children with neurogenic bowel dysfunction where oral medical treatment and retrograde irrigation have failed. 2 In the case of a missing or atrophic appendix, alternative methods must be considered. In our institution, ileal neoappendicostomy (INA) has become the method of choice using the terminal ileum, preserving the ileocecal valve as an antireflux mechanism.…”

Section: Introductionmentioning

confidence: 99%

Ileal Neoappendicostomy in the Treatment of Fecal Incontinence in Children

et al. 2020

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Introduction An antegrade colonic enema (ACE) via an appendicostomy has been shown to be effective in the management of functional bowel problems. In cases with a missing appendix, a neoappendicostomy may be considered. Materials and Methods A retrospective review of clinical outcomes in children who underwent ileal neoappendicostomy for ACE. Medical records were reviewed for data on demography, intra- and postoperative complications. A follow-up questionnaire on stoma problems, ACE-related problems, bowel function, patient satisfaction, well-being, and effect on daily activities was performed. Results Ten patients were included at an average age of 10.6 years at surgery. In half of the patients, minor postoperative complications (Clavien–Dindo grade 2 or less) were found. Nine patients answered the questionnaire with a mean follow-up of 57 months. Despite complaints of stomal leakage, difficulties with catheterization, and pain during irrigation, they reported a high grade of satisfaction, improvements in well-being, and bowel function and the achievement of continence. Conclusion Ileal neoappendicostomy may be an alternative to ACE in children with severe and medically intractable constipation and or/and fecal incontinence where the appendix is missing or not available.

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Medical and surgical management of neurogenic bowel

Abstract: Many medical and surgical options are available for patients with NBoD. Selecting the appropriate medical or surgical treatment involves a careful evaluation of each patient's physical, psychosocial, financial, and geographic variables in an effort to optimize bowel function.

Cited by 32 publications

References 75 publications

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

Neurogenic Bowel Dysfunction in Children and Adolescents

Ileal Neoappendicostomy in the Treatment of Fecal Incontinence in Children

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