Early outcomes of concurrent MACE and Mitrofanoff procedures for management of neuropathic fecal and urinary incontinence in children. Al-Azhar experience.

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.