Evaluation of Malone antegrade continence enema in patients with neurogenic bowel dysfunction

Abstract

Objective To analyze the pathophysiological characteristics of neurogenic bowel dysfunction (NBD) by electrophysiological study of pelvic floor musculature, anorectal manometry and colonic transit study and evaluate the clinical efficacy of Malone antegrade continence enema (MACE). Methods A total of 278 NBD patients received an electrophysiological study of pelvic floor musculature and anorectal manometry from May 2005 to August 2013. Meanwhile, 35 patients underwent colonic transit study and another 20 healthy children were selected as controls. Fifty-one patients underwent MACE. And the preoperative and postoperative anal functions were compared. Results The action potential amplitude of external anal sphincter and levator ani muscle in NBD group (704.0±9.3, 786.0±11.9 mv) increased significantly versus control group (356.0±7.3, 378.0±6.3 mv)and the difference had statistical significance (P<0.05); The action potential time limit of external anal sphincter and levator ani muscle in NBD group (7.6±2.8, 8.9±3.9 ms) was significantly prolonged versus control group (4.8±1.3, 5.0±1.4 ms) and the difference had statistical significance(P<0.05); Pudendal nerve motor conduction amplitude in NBD patients was significantly lower than that in control group [(0.5±0.3) vs (1.7±0.2) mv]. And latent period in NBD patients was significantly prolonged versus control group [(2.6±0.4) vs (1.8±0.3 ms)]. And the differences had statistical significance (P<0.05). The anal resting pressure and anal largest squeeze pressure (33.4±14.1, 78.0±46.8 mmHg) declined significantly and the first defecation sensory threshold (69.1±37.0 ml)increased significantly in NBD patients versus control group (65.3±5.6 mmHg, 161.7±28.0 mmHg, 42.5±15.2 ml)and the difference had statistical significance(P<0.05). The total colonic transit time(72.6±6.6 h)became significantly prolonged in NBD patients, especially for left-half colon (20.9±4.2 h) and sigmoid colon (32.8±5.2 h) versus control group (40.4±7.4, 9.3±4.3, 19.6±6.7 h)and the difference had statistical significance(P<0.05). The clinical postoperative scores (15.7±1.4) obviously improved versus preoperation (5.4±2.8) and the difference had statistical significance (P<0.05). Conclusions NBD patients have defecation and continence dysfunction. And MACE may significantly improve their quality of life. Key words: Neurogenic bowel; Electrophysiology; Enema