Journal of pediatric urology · 2025
Long-term outcomes of antegrade continence enema in adult myelomeningocele patients.
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Alder Nathan, Stanke Joseph, Lewis Jennifer, Slawson Shelly, Frimberger Dominic, Slobodov Gennady
Аннотация
INTRODUCTION: There is limited data on long-term outcomes of antegrade continence enema (ACE) procedures in the treatment of chronic constipation and fecal incontinence in patients with myelomeningocele. These procedures are often performed by urologists for pediatric populations, with limited data on long-term follow-up regarding antegrade continence enema usage and outcomes as patients progress through adulthood. This study provides new insight regarding long term ACE usage and impact on life for a large cohort of adult myelomeningocele patients.
METHODS: We performed a retrospective chart review of all patients from our neurogenic bladder clinic over the last ten years. We identified adult myelomeningocele patients with history of antegrade continence enema procedure. Our database documented current usage of antegrade continence enema, reasons for disuse, stoma complications, revisions, and responses to a questionnaire regarding bowel movements and continence.
RESULTS: 54 patients with myelomeningocele underwent ACE procedures. A total of 21 males (39 %) and 33 females (61 %) with median age of 28 years (21-47 years) were included in the cohort. The median age at surgery was 15 years (0-32 years) and mean follow-up was 141 months (1-327 months). The majority of patients were still regularly using their stoma for enemas (64.8 %). The most common complication was stenosis (20.4 %), with 5 patients (9.3 %) requiring a revision procedure. Fecal incontinence occurred "never" or "less than once every month" in 68.9 % of patients still using their ACE, compared to 18.2 % of those no longer using their ACE (p = 0.007). There was not a statistically significant difference in the frequency of bowel movements between the two groups. Although patients still using their ACE had a lower mean BMI (29.8) than those not using their ACE (33.5), the difference was not statistically significant (p = 0.119).
DISCUSSION: Patients who receive an ACE during childhood and adolescence are likely to maintain stomal patency into adulthood despite potential inconveniences or complications. Limitations of this study include retrospective bias, a small sample size, and subjective questions.
CONCLUSIONS: The majority of patients (64.8 %) in our cohort of adults with myelomeningocele were still using their ACE at a mean follow-up of 11.7 years from surgery. Patients still using their ACE had lower rates of fecal incontinence compared to those no longer using their channel (p = 0.007). This study shows that antegrade continence enemas can be an effective long-term treatment of chronic constipation and fecal incontinence in patients with myelomeningocele.
METHODS: We performed a retrospective chart review of all patients from our neurogenic bladder clinic over the last ten years. We identified adult myelomeningocele patients with history of antegrade continence enema procedure. Our database documented current usage of antegrade continence enema, reasons for disuse, stoma complications, revisions, and responses to a questionnaire regarding bowel movements and continence.
RESULTS: 54 patients with myelomeningocele underwent ACE procedures. A total of 21 males (39 %) and 33 females (61 %) with median age of 28 years (21-47 years) were included in the cohort. The median age at surgery was 15 years (0-32 years) and mean follow-up was 141 months (1-327 months). The majority of patients were still regularly using their stoma for enemas (64.8 %). The most common complication was stenosis (20.4 %), with 5 patients (9.3 %) requiring a revision procedure. Fecal incontinence occurred "never" or "less than once every month" in 68.9 % of patients still using their ACE, compared to 18.2 % of those no longer using their ACE (p = 0.007). There was not a statistically significant difference in the frequency of bowel movements between the two groups. Although patients still using their ACE had a lower mean BMI (29.8) than those not using their ACE (33.5), the difference was not statistically significant (p = 0.119).
DISCUSSION: Patients who receive an ACE during childhood and adolescence are likely to maintain stomal patency into adulthood despite potential inconveniences or complications. Limitations of this study include retrospective bias, a small sample size, and subjective questions.
CONCLUSIONS: The majority of patients (64.8 %) in our cohort of adults with myelomeningocele were still using their ACE at a mean follow-up of 11.7 years from surgery. Patients still using their ACE had lower rates of fecal incontinence compared to those no longer using their channel (p = 0.007). This study shows that antegrade continence enemas can be an effective long-term treatment of chronic constipation and fecal incontinence in patients with myelomeningocele.