Division of Urology, Department of Surgery, College of Medicine and King Saud University Medical City, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia.
J Pediatr Urol. 2019 Feb;15(1):34.e1-34.e5. doi: 10.1016/j.jpurol.2018.08.013. Epub 2018 Aug 28.
Faecal incontinence due to constipation associated with myelomeningocele (MMC) is a frustrating problem. It could have a bad impact on patients and their families' quality of life. Conservative measures could be a starting point. In case of failure, Malone antegrade continence enema (MACE) is commonly considered. However, it is associated with higher complications. Peristeen transanal irrigation (TAI) depends on the injection of water into the colon through a rectal catheter with an inflatable balloon to promote a controlled evacuation of large quantities of faecal contents. Transanal irrigation could be an alternative in these patients to avoid surgery.
The objective of this study was to evaluate the long-term effectiveness and satisfaction of TAI management (Peristeen, Coloplast, Denmark) in children with MMC who failed to respond to conservative measures for stool incontinence.
All patients with MMC who did not respond to conservative measures for stool incontinence and were using TAI with the last follow-up 6 months before the end date were included. Data were collected retrospectively from January 2008 till January 2016. The data collected included the age of starting Peristeen, duration of using the Peristeen, acceptance and compliance of the patient's family with the TAI. Success was defined as stool continence.
A total of 109 patients (55 males and 54 females) diagnosed as having MMC were started on TAI Peristeen. With a mean follow-up of 48 months (24-108), 101 patients (90.4%) achieved complete stool continence and 8 patients were considered failures.
The study results are comparable with those of previously reported publications. The main limitation of Peristeen TAI is that it cannot be performed by the patient himself/herself. This may present a problem with later independence.
Transanal irrigation with Peristeen system is a safe and good alternative option for stool incontinence when other conservative measures fail.
由于脊髓脊膜膨出（MMC）引起的便秘性大便失禁是一个令人沮丧的问题。它可能对患者及其家庭的生活质量产生不良影响。保守治疗可能是一个起点。如果保守治疗失败，通常会考虑使用 Malone 顺行灌洗术（MACE）。然而，它与更高的并发症相关。经肛门直肠内冲洗（TAI）依赖于通过带有可充气球囊的直肠导管将水注入结肠，以促进大量粪便内容物的控制排出。对于这些患者，经肛门直肠内冲洗可能是避免手术的替代方法。
本研究的目的是评估经肛门直肠内冲洗（Peristeen，Coloplast，丹麦）在对大便失禁的保守治疗无反应的 MMC 患儿中的长期疗效和满意度。
所有对大便失禁的保守治疗无反应且正在使用 TAI 的 MMC 患者（最后一次随访在截止日期前 6 个月）都包括在内。数据从 2008 年 1 月至 2016 年 1 月进行回顾性收集。收集的数据包括开始使用 Peristeen 的年龄、使用 Peristeen 的持续时间、患者及其家属对 TAI 的接受和依从情况。成功定义为大便失禁。
共有 109 名男性和 54 名女性患者被诊断为 MMC，开始接受 TAI Peristeen 治疗。平均随访 48 个月（24-108），101 名患者（90.4%）实现完全大便失禁，8 名患者被认为失败。
研究结果与先前报道的文献结果相当。Peristeen TAI 的主要限制是患者本人无法进行操作。这可能会在以后的独立性方面带来问题。
当其他保守治疗失败时，经肛门直肠内冲洗 Peristeen 系统是大便失禁的一种安全且良好的替代选择。
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