WASHINGTON, DC USA (UroToday.com) - The session highlighted that fact that many of the children who are treated for urinary incontinence will have fecal incontinence - and that pediatric urologists are often treating the fecal incontinence.Dr. Mark Cain discussed bowel management in children with neurogenic bladders. He reviewed the options available to these children including medical management, surgical management (ACE) and urinary diversion. He advocated a stepwise approach to the treatment of fecal incontinence in the neurogenic population and that an individualized plan for each patient is needed. The MACE procedure has been demonstrated to be highly effective in treating fecal incontinence in those children who fail medical therapy with success rates > 90%. However the procedure is not without risk, stomal stenosis being one of the more common complications. A device, ACE stopper has been developed to decrease the risk of stomal stenosis, whereas others use a 12 French catheter tied into a knot and left indwelling for a short period of time to treat stomal narrowing. The MACE irrigation protocol may vary from patient to patient but use of tap water with an ave of 640cc irrigated has proven to be successful in 80-85% of children. In some children with high rectal tone, a stimulant may need to be administered before the MACE irrigation.
Moderated by Greg Dean, MD at the 59th Annual Meeting of the Society for Pediatric Urology during the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Pamela I. Ellsworth, MD, Associate Professor Surgery (Urology), Alpert Medical School of Brown University.