Synchronous Bladder Reconstruction and Antegrade Continence Enema

Wedderburn, Andrew; Lee, R.S.; Denny, A.; Steinbrecher, Henrik; Koyle, Martin A.; Malone, P.S.

doi:10.1016/s0022-5347(05)66212-x

Cited by 28 publications

(14 citation statements)

References 12 publications

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“…Several authors have described variations on the classical technique described by Mitrofanoff. Wedderburn [7] and Kajbafzadeh [8] reported the use of the divided appendix in children requiring simultaneous ACE and AV procedures. The split-appendix technique allows the surgeon to create two channels from a single luminal structure.…”

Section: Discussionmentioning

confidence: 99%

Split-appendix technique: Alternative urinary diversion for pediatric complete incontinence

Cerchia¹,

Molinaro²,

Angotti³

et al. 2017

PUCR

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A B S T R A C TWe report our series of selected patients with complete incontinence in whom the appendix was divided and utilized for creating two continent catheterizable stomas. All patients were treated for urinary and fecal incontinence by split appendix technique. The appendix was divided into two different parts preserving adequate perfusion and used for creating an appendicocecostomy (ACE) and an appendicovesicostomy at the same time. After a clinical and radiological follow up, our patients referred a good acceptance and an easily management of the stomas in order to stay dry for all day from urine and feces with improving of their quality of life. The combination of ACE and Mitrofanoff principle have revolutionized the management of urinary and fecal incontinence in patients who are unable to utilize their urethra to keep themselves dry.

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Section: Discussionmentioning

confidence: 99%

Split-appendix technique: Alternative urinary diversion for pediatric complete incontinence

Cerchia¹,

Molinaro²,

Angotti³

et al. 2017

PUCR

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“…However, it is associated with a significant complication rate and requires surgical revision in nearly one-fifth of patients (Table 1). [12][13][14][15][16] Therefore, Malone and colleagues stated that "all conservative measures must be tried first" before the MACE procedure.…”

Section: Discussionmentioning

confidence: 99%

“…9 Since Malone and colleagues presented a preliminary report of an antegrade colonic enema (Malone antegrade continence enema [MACE]) procedure in 1990, 10 it has gained wide acceptance by urologists as a successful treatment for intractable neuropathic bowel dysfunction. [11][12][13][14][15][16] However, the MACE procedure is an invasive operation with a relatively high incidence of complications. [12][13][14][15][16] In recent years, transanal irrigation (TAI) has become a popular option in the management of NBD due to its successful results and acceptable safety profile.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15][16] However, the MACE procedure is an invasive operation with a relatively high incidence of complications. [12][13][14][15][16] In recent years, transanal irrigation (TAI) has become a popular option in the management of NBD due to its successful results and acceptable safety profile. [17][18][19][20][21][22][23] TAI has been suggested as a first-line therapy for children with neuropathic bowel dysfunction who do not respond to conservative medical therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Alenezi¹,

Alhazmi²,

Trbay³

et al. 2014

CUAJ

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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.

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“…Special points The main disadvantage of the surgical approach is that it requires a laparoscopy or laparotomy, which in many of the children that require this procedure involves major surgery, as they have usually had other abdominal surgical procedures [1•]. The advantages for the surgical approach are that it can be done at the same time as the creation of a urinary conduit, the opening can be placed in the umbilicus, and there is no indwelling device [37,38]. The percutaneous procedure represents a less invasive alternative to the surgical procedure.…”

Section: Surgical Approachesmentioning

confidence: 99%

Management of fecal incontinence in children without functional fecal retention

Pensabene¹,

Nurko²

2004

Curr Treat Options Gastro

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The management of the fecal incontinence in children is difficult, and its social consequences are usually devastating. The general objectives of any bowel program are to produce social continence, predictability, and eventually independence. How to achieve those goals depends in part on the underlying condition. In children, fecal incontinence can occur from a variety of conditions. The most common is overflow incontinence from functional fecal retention, but it can also occur in otherwise healthy children with functional nonretentive fecal soiling or in children with organic causes of fecal incontinence, such as congenital malformations, or any other condition affecting the anorectum, anal sphincters, or the spinal cord. The therapeutic regimen that is recommended in patients with nonretentive fecal soiling consists of explanation and support for the child and parents, a nonaccusatory approach, and a toilet training program with a rewarding system. Biofeedback does not play an important role, and laxatives need to be used with caution, as they may exacerbate the incontinence. For those patients with congenital/neuropathic incontinence a combination of maneuvers to change stool consistency, colonic transit, anorectal function, and rectosigmoid evacuation is used. Stool consistency can be changed with the use of dietary interventions or medications. Stool transit can be slowed (antimotility agents) or accelerated (laxatives) with the use of medications. Anorectal function can be improved with the use of biofeedback or procedures to alter sphincter pressure, and the production of a bowel movement can be induced with maneuvers to empty the sigmoid (suppositories, enemas). With the recent advent of the Antegrade Colonic Enema (ACE), the patient is then able to be predictable and independent. This procedure creates a continent conduit from the skin to the cecum that can be catheterized or accessed for self-administration of enemas. The ACE has revolutionized the treatment of children with fecal incontinence.

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Synchronous Bladder Reconstruction and Antegrade Continence Enema

Cited by 28 publications

References 12 publications

Split-appendix technique: Alternative urinary diversion for pediatric complete incontinence

Split-appendix technique: Alternative urinary diversion for pediatric complete incontinence

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

Management of fecal incontinence in children without functional fecal retention

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