Left‐colon antegrade enema (LACE): Long‐term experience with the Macedo‐Malone approach

Anselmo, Christophe Bezerra; Amaral, Rafael D.R. do; Oliveira, Diego Estevam; Cruz, Marcela Leal da; Liguori, Riberto; Garrone, Gilmar; Leslie, Bruno; Ottoni, Sérgio Leite; Ortiz, Valdemar; Macedo, António

doi:10.1002/nau.22880

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Today, retrograde transanal irrigation is one of the most important treatment options, as regular irrigations significantly reduce the risk for fecal incontinence . Retrograde transanal irrigation can become difficult or impossible due to anatomic or social circumstances and can, therefore, be transformed into an antegrade irrigation fashion, using a Malone antegrade continence enema‐stoma …”

Section: Methodsmentioning

confidence: 99%

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment

Stein

Bogaert

Doğan

et al. 2019

Neurourology and Urodynamics

112

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Background: In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia.Aims: Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). Material and Methods: After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. Results: The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. ORCID Raimund Stein

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Section: Methodsmentioning

confidence: 99%

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment

Stein

Bogaert

Doğan

et al. 2019

Neurourology and Urodynamics

112

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“…New techniques have been developed: laparoscopic (Kim, Beasley and Maoate, 2006), robotassisted laparoscopic (Zee, Kern and Herndon, 2017), left colon location (Anselmo et al, 2017), use of a tube in the stoma (Bevill et al, 2017), and cecostomy (Halleran et al, 2019).…”

Section: Antegrade Colonic Enemas (Ace)mentioning

confidence: 99%

Neurogenic bladder and bowel dysfunction : Clinical aspects in children with spinal dysraphism

Wide

2020

Linköping University Medical Dissertations

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Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family. Most individuals with SD suffer from neurogenic bladder and bowel dysfunction-with the risk of urinary tract infections, renal deterioration, urinary and fecal incontinence-that affects social participation and quality of life negatively. In newborns with SD, early detection of neurogenic bladder dysfunction and determination of post-void residual urine are required to determine the need of clean intermittent catheterization (CIC) and follow-up.The non-invasive method of four-hour voiding observation with provocation test (VOP) was used to evaluate bladder function in 50 newborn children with SD. Voiding patterns for the children were described and compared with those of 50 healthy newborns evaluated with VOP in an earlier study. Comparison revealed significant differences among several variables. In particular, leakage at provocation test and not voiding with a stream were common in newborns with SD but did not occur in healthy newborns. VOP is a non-invasive standardized method to determine residual urine in newborns with SD. It also adds information on voiding pattern, frequency, voiding with a stream and leakage at provocation.

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“…If retrograde transanal irrigation is difficult or impossible due to anatomic or social circumstances antegrade irrigation can be performed by using a Malone Antegrade Continence Enema (MACE)-appendicostomy. 83,84 In a long-term study of 105 patients, 69% had successful bowel management, however, stomal complications occurred in 63% (infection, leakage, and stenosis), 33% required surgical revision, and 6% eventually required diverting stomas. 85 In addition, patients need to be informed, that the antegrade irrigation is also time-consuming with durations of at least 20 to 60 minutes.…”

Section: Of Fecal Constipationmentioning

confidence: 99%

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

Stein

Bogaert

Doğan

et al. 2019

Neurourology and Urodynamics

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Background: Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimeseven in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. Material & Methods: After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update.Results: In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. Conclusion:In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early. K E Y W O R D Sbladder augmentation, bladder neck reconstruction, EAU guideline, Mitrofanoff stoma, neurogenic bladder, sling procedure, urinary diversion

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Left‐colon antegrade enema (LACE): Long‐term experience with the Macedo‐Malone approach

Cited by 8 publications

References 18 publications

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment

Neurogenic bladder and bowel dysfunction : Clinical aspects in children with spinal dysraphism

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

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