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11–14 APRIL, 2018, HELSINKI, FINLAND
17:08–17:11
S20-5 (PP)
ANTEGRADE CONTINENCE ENEMA (ACE) CONDUITS FOR
FECAL INCONTINENCE MAY IMPROVE LOWER URINARY
TRACT SYMPTOMS IN MALES WITH SEVERE ANORECTAL
MALFORMATIONS
Kristiina KYRKLUND, Seppo TASKINEN, Eija MÄKELÄ, Risto J RINTALA and Mikko
P PAKARINEN
Hospital for Children and Adolescents, University of Helsinki, Pediatric Surgery, Helsinki, FINLAND
PURPOSE
Rectourethral fistula (RUF) is a rare and severe type of anorectal malformation (ARM) associated
with impaired bowel function and lower urinary tract symptoms (LUTS). We investigated whether
ACE conduits for achieving social fecal continence also secondarily improves LUTS.
MATERIAL AND METHODS
The records of all males treated for RUF with posterior sagittal anorectoplasty between
1983–2006 and requiring ACE for poor fecal control were retrospectively reviewed. Patients with
major sacral anomalies (<3 segments remaining) or cognitive impairment were excluded.
RESULTS
Of 43 males with RUF, 15 (35 %; median age 21 (range,11–32) years; 2 bulbar, 8 prostatic, 4 blad-
derneck fistulas) had undergone ACE at a median age of 8 (range,4,5–22) years. None were lost
to follow-up. There were 3 cases of grade III VUR (20 %), 1 horseshoe kidney, 1 ectopic ureter
requiring neoimplantation and 1 hypospadias repair. Before ACE, 53 % (n=8) had daily daytime
stress or urge urinary incontinence (UI), 27 %(n=4) reported bedwetting and 27 % (n=4;3 bladder-
neck RUF) still wore diapers. ¾ patients with daily UI had detrusor overactivity on urodynamics but
normal bladder capacity; 1 also had obstructive bladder emptying requiring intermittent catheteriza-
tion. In 0,2–2 years following ACE, social continence for stool was achieved in 93 % (14/15) and
contemporaneous improvement in LUTs was observed in 7/8 cases so that patients discontinued
diapers and were daytime and night-time dry. One patient with bladderneck fistula and obstructive
symptoms continued with intermittent catheterization and anticholinergics beyond 2 years after an
ACE. No patients required further reconstructive urologic surgery.
CONCLUSIONS
Improving bowel function with ACE may secondarily reduce LUTS and improve urinary continence
in males with severe ARMs.
17:11–17:20
Discussion