Peristeen anal irrigation as a substitute for the MACE procedure in children who are in need of reconstructive bladder surgery

Abstract

Cite as: Can Urol Assoc J 2014;8(1-2):e12-5. http://dx.doi.org/10.5489/cuaj.1263 Published online January 14, 2014. AbstractIntroduction: We evaluate the efficacy of the Peristeen (Coloplast A/S, Kokkedal, Denmark) transanal irrigation (TAI) system, as a stool cleansing mechanism, to gain stool continence in children who need reconstructive bladder surgery and have fecal incontinence. Methods: We prospectively evaluated children with neuropathic bladder and bowel dysfunction who were intended for reconstructive bladder surgery and the Malone antegrade continence enema (MACE) procedure. All patients were started on the Peristeen TAI system at least 3 months before surgery to assess their response. Each patient's bowel function, frequency of using the system, satisfaction (and that of their parents) and diaper independency were evaluated before and after reconstructive surgery. Results: We included 18 patients (11 female, 7 male) who were evaluated from April 2006 to the present. The mean age of the group was 7.6 years (range: 4-15). Fifteen patients (83.3%) showed complete dryness from stools. Of the 15 patients, 8 (53.3%) were able to be diaper-free, while 6 continued wearing diapers due to fear of soiling and 1 due to urinary incontinence. The patients underwent reconstructive bladder surgery and continued to use the Peristeen TAI system with the same results postoperatively. The main limitation of this study is the small number of patients included, although this is a very specific patient group. Conclusion: Our initial results suggest that the Peristeen TAI system is a successful conservative substitute for the MACE procedure in children who require reconstructive bladder surgery.

Peristeen Transanal Irrigation System to Manage Bowel Dysfunction: A NICE Medical Technology Guidance

“…Cedar undertook a comprehensive search and selection process (Fig. 1 ) and included a further 4 observational studies of adults[ 12 – 15 ] and a further 10 observational studies of children [ 16 – 25 ]. The main outcomes in the included studies were patient-reported outcomes, which, due to the nature of the device, was appropriate.…”

Total endoscopic and anal irrigation management approach to noncompliant neuropathic bladder and bowel in children: A long-term follow-up

“…Trans anal irrigation to manage SI was used and tested previously in our institute and others[ 17 18 19 ] with good results, in an effort to avoid major surgical reconstruction.…”

Prospective evaluation of Peristeen® transanal irrigation system with the validated neurogenic bowel dysfunction score sheet in the pediatric population

“…These studies have been very promising with ranges of about 80% of those enrolled achieving social fecal continence . Alenezi et al's study looked at 18 patients with NBD who were scheduled to undergo bladder reconstruction and MACE surgeries . These children utilized Peristeen for 3 months before their planned surgery and 83% did well with the device and only underwent their bladder surgeries, holding off on their MACE …”

“…[18][19][20] Alenezi et al's study looked at 18 patients with NBD who were scheduled to undergo bladder reconstruction and MACE surgeries. 21 These children utilized Peristeen for 3 months before their planned surgery and 83% did well with the device and only underwent their bladder surgeries, holding off on their MACE. 21 The potential cost savings of Peristeen 1 versus conservative bowel management has been previous examined in a randomized trial for adult spinal cord patients over a 10 week period.…”

“…21 These children utilized Peristeen for 3 months before their planned surgery and 83% did well with the device and only underwent their bladder surgeries, holding off on their MACE. 21 The potential cost savings of Peristeen 1 versus conservative bowel management has been previous examined in a randomized trial for adult spinal cord patients over a 10 week period. In this analysis it was noted that productrelated costs for Peristeen 1 was higher although the costs to the carer were lower, as were costs with associated urinary tract infections and patient time.…”