Short versus mid-long-term outcome of transanal irrigation in children with spina bifida and anorectal malformations

Ausili, Emanuele; Marte, Antonio; Brisighelli, Giulia; Midrio, Paola; Mosiello, Giovanni; Pergola, Enrico La; Lombardi, Laura; Iacobelli, Barbara Daniela; Caponcelli, Enrica; Meroni, Milena; Leva, Ernesto; Rendeli, Claudia

doi:10.1007/s00381-018-3860-4

Cited by 19 publications

(40 citation statements)

References 29 publications

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“…Twelve studies reported interventions using medically assisted techniques that focused solely on faecal continence. 38,55,58,59,[61][62][63][64]70,71,74,77,78,80,85,90 Seven studies looked at the use of transrectal or transanal irrigation (TAI) to improve faecal continence. Both of these interventions are the same and involve the irrigation of the rectum and lower colon using fluid inserted via a catheter that is passed through the anus into the rectum.…”

Section: Medically Assisted Techniquesmentioning

confidence: 99%

“…One study 70 focused on transrectal irrigation (TRI); the majority (35/40) of participants with spina bifida were still using TRI at follow-up and all participants were continent and free of constipation. Five studies focused on TAI using Peristeen; [62][63][64]78,85,90 Two studies 58,71 reported the outcomes of interventions using anal plugs in 18-20 children and young people with spina bifida aged 4-29 years. Both studies reported overall improvements in patientreported outcomes relating to the impact of faecal incontinence on daily life.…”

Section: Medically Assisted Techniquesmentioning

confidence: 99%

“…Improved QoL scores indicated that the intraurethral self-retaining device significantly reduced how urinary incontinence affected QoL in both children and adolescents (p < 0.0001). Five studies [62][63][64]78,90 focused on TAI using Peristeen in children and young people with spina bifida. One study 90 reported results of the use of TAI (Peristeen) for faecal incontinence in 24 children and young people with neuropathic bowel and anorectal malfunctions (ARMs).…”

Section: Synthesis Of Qualitative and Quantitative Evidencementioning

confidence: 99%

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Improving continence in children and young people with neurodisability: a systematic review and survey

Eke

Hunt

Ball

et al. 2021

Health Technol Assess

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Background Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. Objective The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. Design A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. Results Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. Limitations Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. Conclusions Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. Future work There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. Study registration This study is registered as PROSPERO CRD42018100572. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 73. See the NIHR Journals Library website for further project information.

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Section: Medically Assisted Techniquesmentioning

confidence: 99%

Section: Medically Assisted Techniquesmentioning

confidence: 99%

Section: Synthesis Of Qualitative and Quantitative Evidencementioning

confidence: 99%

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Improving continence in children and young people with neurodisability: a systematic review and survey

Eke

Hunt

Ball

et al. 2021

Health Technol Assess

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“…Before the introduction of a revised method of transanal irrigation (TAI) [8], many children were treated surgically with a Malone antegrade continence enema [7] or colostomy. TAI has transformed the management of NBD, and now is widely used in adults and children with SB [9][10][11][12]. Thanks to the improved survival of children with neurological conditions that were previously considered fatal, and better awareness and diagnostic techniques, the worldwide population of children and adolescents with NBD is growing.…”

Section: Introductionmentioning

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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“…In the decade since, multiple authors have discussed the utility of emptying the colon mechanically with antegrade enemas or trans-anal (retrograde) irrigations [5][6][7]. This practice allows the colon to be mechanically cleaned and with the goal to prevent incontinence episodes until stool moves around to the rectum, which is then emptied with a subsequent enema or flush.…”

Section: Introductionmentioning

confidence: 99%

One-year impact of a bowel management program in treating fecal incontinence in patients with anorectal malformations

Wood

Vilanova-Sánchez

El-Gohary

et al. 2021

Journal of Pediatric Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Short versus mid-long-term outcome of transanal irrigation in children with spina bifida and anorectal malformations

Cited by 19 publications

References 29 publications

Improving continence in children and young people with neurodisability: a systematic review and survey

Improving continence in children and young people with neurodisability: a systematic review and survey

Neurogenic Bowel Dysfunction in Children and Adolescents

One-year impact of a bowel management program in treating fecal incontinence in patients with anorectal malformations

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