Total Continence Reconstruction Using the Artificial Urinary Sphincter and the Malone Antegrade Continence Enema

Abstract

Urinary and fecal continence in patients with myelomeningocele is achievable with a single total continence reconstruction procedure using the artificial urinary sphincter and the Malone antegrade continence enema with durable results.

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

“…4,31 The collection methods were interviews during follow-up visits 6,15,20,25,43 or telephone contacts 4,7,12,17,23,32,38 or both. 16,31,37,41 The follow-up period of SB patients after starting bowel management varied from 3, 15,19,20,22,23,41,42 over 12, 12,13,21,25,31 30 [16][17][18][27][28][29][30]34,39 and 60 months 24,32,33,35,36,40,43 to 120 months. 38,43 To explore different treatment modalities for bowel management in SB and their effectiveness the studies were grouped according to the treatment modality: conservative bowel management (16 studies), electrical stimulation (4 studies) and non-conservative (surgical) bowel management (17 studies).…”

“…28,[30][31][32][35][36][37][38][39]43 Some studies (5/17) gave no definition for fecal pseudo-continence 27,29,33,40,41 or a less-strict definition. 42 One study evaluated incontinence with a 5-point Likert scale.…”

“…43 The time spent for treatment was not reported in nine studies. [28][29][30]33,35,36,[38][39][40] If reported, it varied from 30 27,37,43 to 50 min. 31,32,34,[41][42][43] Complications are an important issue in case of surgical treatment.…”

“…The most frequently reported complications were stomal stenosis, wound infections and perforations. Redo surgery for complications varied from 5 29,38 over 10% 27,36,40 to an even higher rate of 30%. 28,31,32,42 Overall redo surgery was necessary in 23% (142/616) of patients.…”

Artificial sphincter

“…These patients must perform intermittent catheterization, so the cuff placement is best placed at the bladder neck. Different groups reported safety and efficacy for myelomenigocele [32][33][34] and SCI patients [33][34][35] with a social cure rate of about 70%, with an acceptable complication rate. Compared with those patients in which an AUS is placed around the bladder neck without neurogenic SUI indications, the success rate is reported to be over 95%.…”