International urology and nephrology · 2026
Early outcomes of concurrent MACE and Mitrofanoff procedures for management of neuropathic fecal and urinary incontinence in children. Al-Azhar experience.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Daboos Mohammad, Abokifa Amin, Salama Ahmed, Fawzy Mohamed, Abdelmaboud Mohamed, Azab Ahmed
Аннотация
OBJECTIVES: To evaluate the short-term safety, feasibility, and impact on quality of life of performing concurrent Malone antegrade continent enema (MACE) and Mitrofanoff appendicovesicostomy procedures in a single session for children with neuropathic combined fecal and urinary incontinence.
PATIENTS AND METHODS: This prospective study involved 30 patients with neuropathic combined incontinence unresponsive to conservative management, from January 2022 to July 2025. All underwent concurrent MACE and Mitrofanoff procedures. Appendices ≥ 10 cm were split; for shorter appendices (< 10 cm), a colonic flap neoappendicostomy was created for MACE. Primary outcomes were intraoperative and postoperative complications. Secondary outcomes included functional results and quality of life (QOL) assessed using a modified questionnaire.
RESULTS: Our findings revealed no intraoperative complications. Early postoperative complications were confined to wound infections (6.7%), while late complications included bladder neck leakage (10.0%). Stomal stenosis, difficult catheterization, or prolapse were not observed during a median follow-up of 12 months (range 6-18). Functional outcomes showed mean catheterization intervals of 6.6 ± 1.7 h for Mitrofanoff and 37.1 ± 13.2 h for MACE. QOL scores improved significantly from a preoperative mean of 4.0 ± 2.1 (86.6% poor) to 13.0 ± 2.4 postoperatively (90.0% good; p < 0.001).
CONCLUSION: Concurrent MACE and Mitrofanoff procedures are a feasible and safe surgical option in the short term, significantly improving quality of life for children with neurogenic bowel and bladder dysfunction. Larger, long-term studies are needed to confirm durability and evaluate complication rates over time.
PATIENTS AND METHODS: This prospective study involved 30 patients with neuropathic combined incontinence unresponsive to conservative management, from January 2022 to July 2025. All underwent concurrent MACE and Mitrofanoff procedures. Appendices ≥ 10 cm were split; for shorter appendices (< 10 cm), a colonic flap neoappendicostomy was created for MACE. Primary outcomes were intraoperative and postoperative complications. Secondary outcomes included functional results and quality of life (QOL) assessed using a modified questionnaire.
RESULTS: Our findings revealed no intraoperative complications. Early postoperative complications were confined to wound infections (6.7%), while late complications included bladder neck leakage (10.0%). Stomal stenosis, difficult catheterization, or prolapse were not observed during a median follow-up of 12 months (range 6-18). Functional outcomes showed mean catheterization intervals of 6.6 ± 1.7 h for Mitrofanoff and 37.1 ± 13.2 h for MACE. QOL scores improved significantly from a preoperative mean of 4.0 ± 2.1 (86.6% poor) to 13.0 ± 2.4 postoperatively (90.0% good; p < 0.001).
CONCLUSION: Concurrent MACE and Mitrofanoff procedures are a feasible and safe surgical option in the short term, significantly improving quality of life for children with neurogenic bowel and bladder dysfunction. Larger, long-term studies are needed to confirm durability and evaluate complication rates over time.