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Achieving fecal continence in patients with spina bifida : a descriptive cohort study

(2007) JOURNAL OF UROLOGY. 178(6). p.2640-2644
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Organization
Abstract
Purpose: Fecal incontinence is a major problem in patients with myelomeningocele. We evaluate the results of a stratified approach aimed at obtaining fecal pseudo-continence in patients with myelomeningocele. Materials and Methods: We conducted a cross-sectional descriptive study of last file data in 80 patients 5 to 18 years old with myelomeningocele followed at our center. Beginning at birth patients with myelomeningocele were seen at least annually by the pediatric gastoenterologist, a member of the multidisciplinary "spina team." Constipation was treated with diet and osmotic laxatives. Starting at age 5 years, treatment was targeted at achieving pseudo-continence. A toilet training scheme was started, associated with induced defecation by digital stimulation. Retrograde tap water enemas were used in patients with unsatisfactory results. If retrograde enemas were unsuccessful, an antegrade continence enema procedure was proposed. For children unable to sit on a toilet regular manual evacuation of stools was advised. Results: Eight of the 80 patients were fecal continent. Pseudo-continence was achieved in 50 of the 72 incontinent patients (69%), including 5 of 5 following only a strict toilet scheme, 21 of 24 (87.5%) performing retrograde enemas, 16 of 20 (80%) performing orthograde enemas through an antegrade continence device and 8 of 10 performing regular manual evacuation of stools. In 4 of the 20 patients (20%) performing orthograde enemas complications led to closure of the antegrade continence device. Treatment failed and was stopped in 17 patients. Success of treatment was not related to level of spinal lesion or degree of mobility. Conclusions: Fecal pseudo-continence was achieved in 58 of 80 patients (72.5%) with myelomeningocele.
Keywords
fecal incontinence, spina bifida cystica, meningomyelocele, child, BOWEL MANAGEMENT, CHILDREN, ENEMA, INCONTINENCE, MYELOMENINGOCELE, MALONE

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MLA
Vande Velde, Saskia, Stephanie Van Biervliet, Katrien Van Renterghem, et al. “Achieving Fecal Continence in Patients with Spina Bifida : a Descriptive Cohort Study.” JOURNAL OF UROLOGY 178.6 (2007): 2640–2644. Print.
APA
Vande Velde, Saskia, Van Biervliet, S., Van Renterghem, K., Van Laecke, E., Hoebeke, P., & Van Winckel, M. (2007). Achieving fecal continence in patients with spina bifida : a descriptive cohort study. JOURNAL OF UROLOGY, 178(6), 2640–2644.
Chicago author-date
Vande Velde, Saskia, Stephanie Van Biervliet, Katrien Van Renterghem, Erik Van Laecke, Piet Hoebeke, and Myriam Van Winckel. 2007. “Achieving Fecal Continence in Patients with Spina Bifida : a Descriptive Cohort Study.” Journal of Urology 178 (6): 2640–2644.
Chicago author-date (all authors)
Vande Velde, Saskia, Stephanie Van Biervliet, Katrien Van Renterghem, Erik Van Laecke, Piet Hoebeke, and Myriam Van Winckel. 2007. “Achieving Fecal Continence in Patients with Spina Bifida : a Descriptive Cohort Study.” Journal of Urology 178 (6): 2640–2644.
Vancouver
1.
Vande Velde S, Van Biervliet S, Van Renterghem K, Van Laecke E, Hoebeke P, Van Winckel M. Achieving fecal continence in patients with spina bifida : a descriptive cohort study. JOURNAL OF UROLOGY. 2007;178(6):2640–4.
IEEE
[1]
S. Vande Velde, S. Van Biervliet, K. Van Renterghem, E. Van Laecke, P. Hoebeke, and M. Van Winckel, “Achieving fecal continence in patients with spina bifida : a descriptive cohort study,” JOURNAL OF UROLOGY, vol. 178, no. 6, pp. 2640–2644, 2007.
@article{394361,
  abstract     = {Purpose: Fecal incontinence is a major problem in patients with myelomeningocele. We evaluate the results of a stratified approach aimed at obtaining fecal pseudo-continence in patients with myelomeningocele. 
Materials and Methods: We conducted a cross-sectional descriptive study of last file data in 80 patients 5 to 18 years old with myelomeningocele followed at our center. Beginning at birth patients with myelomeningocele were seen at least annually by the pediatric gastoenterologist, a member of the multidisciplinary "spina team." Constipation was treated with diet and osmotic laxatives. Starting at age 5 years, treatment was targeted at achieving pseudo-continence. A toilet training scheme was started, associated with induced defecation by digital stimulation. Retrograde tap water enemas were used in patients with unsatisfactory results. If retrograde enemas were unsuccessful, an antegrade continence enema procedure was proposed. For children unable to sit on a toilet regular manual evacuation of stools was advised. 
Results: Eight of the 80 patients were fecal continent. Pseudo-continence was achieved in 50 of the 72 incontinent patients (69%), including 5 of 5 following only a strict toilet scheme, 21 of 24 (87.5%) performing retrograde enemas, 16 of 20 (80%) performing orthograde enemas through an antegrade continence device and 8 of 10 performing regular manual evacuation of stools. In 4 of the 20 patients (20%) performing orthograde enemas complications led to closure of the antegrade continence device. Treatment failed and was stopped in 17 patients. Success of treatment was not related to level of spinal lesion or degree of mobility. 
Conclusions: Fecal pseudo-continence was achieved in 58 of 80 patients (72.5%) with myelomeningocele.},
  author       = {Vande Velde, Saskia and Van Biervliet, Stephanie and Van Renterghem, Katrien and Van Laecke, Erik and Hoebeke, Piet and Van Winckel, Myriam},
  issn         = {0022-5347},
  journal      = {JOURNAL OF UROLOGY},
  keywords     = {fecal incontinence,spina bifida cystica,meningomyelocele,child,BOWEL MANAGEMENT,CHILDREN,ENEMA,INCONTINENCE,MYELOMENINGOCELE,MALONE},
  language     = {eng},
  number       = {6},
  pages        = {2640--2644},
  title        = {Achieving fecal continence in patients with spina bifida : a descriptive cohort study},
  url          = {http://dx.doi.org/10.1016/j.juro.2007.07.060},
  volume       = {178},
  year         = {2007},
}

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