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Experience with Glycerin for Antegrade Continence Enema in Neurogenic Bowel Management.
MedLine Citation:
PMID:  22986031     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Malone antegrade continence enemas (MACE) are employed in the management of neurogenic bowel to attain fecal continence. Several different irrigation solutions have been described, but glycerin, an osmotic laxative that promotes peristalsis, has been rarely mentioned or studied. We sought to assess clinical outcomes in our patients with MACE patients using glycerin-based irrigation. MATERIALS AND METHODS: Our series of neurogenic bowel patients from 1997-2011 undergoing MACE procedures was retrospectively reviewed. Glycerin diluted with tap water followed by a tap water flush is our preferred irrigation protocol. Bowel regimen outcomes examined included fecal continence, emptying time, leakage from stoma, as well as enema volume, frequency, and independence. RESULTS: Of the 23 patients with follow-up >6 months, 19 used glycerin-based irrigation. Average age at surgery was 8.8 years. Patients using glycerin instilled a median and mean of 30cc and 29cc, respectively, of glycerin, plus a median and mean of 50cc and 131cc, respectively, of tap water. Fecal continence rate was 95%, stoma leakage rate was 16%, and only 16% of patients required daily irrigation. CONCLUSION: Glycerin is a viable and effective alternative irrigant for antegrade enemas of neurogenic bowel, with an excellent rate of fecal continence. The volume of irrigant needed was typically less than 90 mL which is much less than in published reports using tap water alone.
Authors:
David I Chu; Zarine R Balsara; Jonathan C Routh; Sherry S Ross; John S Wiener
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-14
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Section of Pediatric Urology, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
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