Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the antegrade continence enema procedure*

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Abstract
To report our experience with synchronous bladder reconstruction and the antegrade continence enema (ACE) procedure in the management of neuropathic urinary and faecal incontinence. Eight patients (four boys, four girls) with a median age of 9 years 10 months (range 4.5-17) were treated. Five had spina bifida, two high ano-rectal malformations and one had been successfully treated for a spinal neuroblastoma. The appendix was used for the ACE procedure in five patients and a tubularized caecal or colonic flap in the other three. Seven patients had an augmentation cystoplasty and one a cystectomy with a continent diversion. A bladder neck reconstruction or an urethral lengthening procedure was performed in five patients and the bladder outlet was closed in two. Six patients required some form of revision. Four patients underwent a simultaneous Mitrofanoff procedure. The median length of follow-up was 11.5 months (range 3-29). Five patients were completely clean and the remaining three experienced minor faecal soiling only. They were all delighted with the result. Six patients were dry day and night, one was wet at night only while the final patient was wet day and night. Synchronous surgical procedures to make patients with neuropathic incontinence both clean and dry is effective, but most patients require revision surgery. Patient motivation and selection and the availability of a nurse specialist is crucial in obtaining satisfactory results.