CONTEMPORARY BOWEL MANAGEMENT PROTOCOL FOR PATIENTS WITH CLOACAL EXSTROPHY

You have accessJournal of UrologyPediatrics: Reconstructive Surgery - Diversion, Endourology & Transplantation, Trauma1 Apr 20121205 CONTEMPORARY BOWEL MANAGEMENT PROTOCOL FOR PATIENTS WITH CLOACAL EXSTROPHY Blake Palmer, Logan Campbell, Jake Klein, Dominic Frimberger, and Bradley Kropp Blake PalmerBlake Palmer Oklahoma City, OK More articles by this author , Logan CampbellLogan Campbell Oklahoma City, OK More articles by this author , Jake KleinJake Klein Oklahoma City, OK More articles by this author , Dominic FrimbergerDominic Frimberger Oklahoma City, OK More articles by this author , and Bradley KroppBradley Kropp Oklahoma City, OK More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1472AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As the initial medical management of cloacal exstrophy has improved and the expectation for healthy growth into adult exists the focus of management has shifted to maximizing their quality of life. Current literature shows a composite 26.1% fecal continence rate over three large center series. Our focus is to evaluate an aggressive bowel management algorithm for achievement of fecal continence in patients with cloacal exstrophy. METHODS A retrospective chart review was performed evaluating 18 patients with cloacal extrophy and cloacal extrophy variants from 1996 to 2011. Patients included infants who had their primary surgeries at the Children's Hospital of Oklahoma as well as those referred from outside institutions. Data collected included demographics, bowel management, bladder management, and associated anomalies. Bowel management included whether patients had a colostomy, ileostomy, antegrade continent enema (ACE), or continent fecal reservoir, and whether patients were using medications to improve bowel continence. In patients who were being managed with an ACE it was documented how many times they flushed the device and whether or not they were able to achieve continence in between flushes. Certain adverse outcomes, such as diaper rash, were also documented. RESULTS Our institution provided primary management for seven of these patients and 11 were primarily managed by outside institutions. Of the 18 patients, six have had a pullthrough and takedown procedure, 10 have an ileostomy/colostomy, and two have a continent fecal reservoir. Of the patients pulled through, five have an ACE/cecostomy button, and four out of those five are continent. The other patient is one month out from an ACE procedure and his continence status is too early from surgery to determine. Of the seven patients primarily managed by our institution's aggressive bowel protocol, six have had a pullthrough and takedown and one is scheduled for takedown in the near future. One patient has been continent with pullthrough and takedown alone. Five patients have an ACE/cecostomy button. Four of these patients are continent with the fifth being one month out from the procedure, giving a total fecal continence rate of (5/7) 71.4%. No patients had long term surgical or medical complications or have had to have an ostomy done after pull through and takedown. CONCLUSIONS Pull-through procedures and use of ACE/cecostomy buttons can dramatically improve the fecal continence rates in patients with cloacal exstrophy without the use of stomas. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e487-e488 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blake Palmer Oklahoma City, OK More articles by this author Logan Campbell Oklahoma City, OK More articles by this author Jake Klein Oklahoma City, OK More articles by this author Dominic Frimberger Oklahoma City, OK More articles by this author Bradley Kropp Oklahoma City, OK More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...