The Malone antegrade colonic enema isolated or associated with urological incontinence procedures: Evaluation from patient point of view

Purpose: Fecal and urinary incontinence in patients with congenital or acquired spinal cord defects represents a handicap that impairs chances of integration in society. Associated with the management of urinary incontinence, the Malone antegrade colonic enema is a generally successful procedure for resolving refractory fecal incontinence. We report the results of the evaluation of this technique from the patient perspective. Materials and Methods: A survey was conducted among 19 patients who had undergone a Malone procedure, combined in 14 with urological surgical intervention for urinary incontinence. Patients completed a questionnaire either by mail or during an interview with a urotherapy nurse and/or a psychologist. Questions concerned patient opinion about the quality of preoperative information, perioperative period, stoma, functional result and overall satisfaction. The psychological impact of the procedure was also evaluated during the interviews. No complication occurred related to the Malone procedure or stomal stenosis, and a perfect functional result was achieved in 17 patients, 1 of whom had occasional leakage through the stoma. Results: Of the 19 patients in the study 2 who have abandoned using the Malone procedure, including 1 with a poor result and 1 with a good functional result, did not return the questionnaire. The remaining 17 patients believed they had received adequate preoperative information and expressed no specific complaint about the perioperative period. The 15 with the stoma in the umbilicus were satisfied, although 3 young patients were temporarily disturbed by catheterizing the umbilicus and 2 with the stoma in the right fossa iliaca were disappointed. The 15 patients who had a perfect functional result recognized great improvement in quality of life but 13 complained of pain (12) and/or excessive duration of the procedure (9). The patient with a poor functional result and the other with occasional stomal leakage would not consider the procedure again. These 2 patients had durable postoperative depression while 3 others who ultimately achieved a good functional result experienced temporary depression. Conclusions: The Malone procedure generally meets the expectations of patients but it is considered by a majority as painful and lengthy. The umbilicus is the preferred stoma site but may prove to be disturbing in young patients. Abandonment of the procedure and postoperative depression experienced by some patients, despite a good functional result, deserve better prevention.