Long-term results for malone antegrade continence enema for adults with neurogenic bowel disease

Objectives. To determine the long-term outcomes from the Malone antegrade continence enema (ACE) procedure in adult neurogenic patients. Methods. A retrospective review of adult patients who underwent the ACE procedure for neurogenic bowel was done. Patients were studied if they had follow-up of greater than 4 years. We compared pre-ACE and post-ACE toileting times, bowel continence status, and complications, and elicited patient subjective satisfaction with their quality of life. Results. Six patients were available for study. Mean age was 35 years with a mean follow-up of 4.5 years. Urinary diversion was done in 5 patients. Pre-ACE toileting time was 190 ± 45 minutes versus post-ACE toileting time of 28 ± 20 minutes (P <0.001). Four of six patients pre-ACE were incontinent of stool per rectum compared with 1 of these 4 patients post-ACE (P = 0.03). Five patients were continent of stool per ACE stoma. Four patients (67%) had complications. Three of five patients (60%) who underwent synchronous urinary diversion required postoperative re-exploration. Five patients (83%) were satisfied with their outcome and rated their quality of life higher after the ACE procedure compared with pre-ACE. Conclusions. The ACE procedure is effective in the long-term management of adult neurogenic bowel. The complication and re-exploration rates are high. Patients must be properly selected to determine appropriate motivation.