296 THE JOURNAL OF UROLOGY® Vol. 179, No. 4, Supplement, Monday, May 19, 2008

853THE ROLE OF RETROGRADE COLONIC ENEMA IN CHILDREN WITH SPINA BIFIDA: IS IT INFERIOR TO THE ANTEGRADE CONTINENCE ENEMA?Daisuke Matsuno*, Yuichiro Yamazaki, Mari Suzuki, Yoshiyuki Shiroyanagi, Ayako Hagiwara, Terumi Ichiroku. Yokohama, Japan.

INTRODUCTION AND OBJECTIVE: The Malone antegrade continence enema (MACE) procedure has been reported as a very useful technique to resolve faecal incontinence or constipation in children with

of surgery. On this point, the retrograde colonic enema (RCE) is still the mainstay of conservative treatment. The aim of this study is to determine whether RCE is inferior to the MACE in the management of fecal incontinence.

introduced in the program of colonic emptying due to fecal incontinence in the last 3 year-period. Of these, 10 began RCE (3 boys, 7 girls) and 13 underwent MACE procedure (9 boys, 4 girls). To compare these 2

during procedure, time to perform washout, procedure frequency,

performed by the interview and the review of medical records. Unpairedt-test and Fisher’s exact test were used for statistic evaluation.

RESULTS: Average age at introduction of the program was 8.8 y.o. in RCE group and 14.0 y.o. in MACE group. Mean follow-up periods of RCE and MACE group were 23.2 months and 23.6 months, respectively. In MACE group, all children except one underwent MACEoperation concomitantly with bladder augmentation. Results of the

RCE (n:10) MACE (n:13) p valuefaecal continence(cases) 7 (70.0%) 8 (61.5%) >0.99pain during procedure(cases) 1 (10.0%) 7 (53.8%) 0.074time to perform washout(min, average) 33.3 36.7 0.53procedure frequency (times per week, average) 4.6 4.2 0.67independence of performance (cases) 1 (10.0%) 8 (61.5%) 0.029dropout (cases) 1 (10.0%) 1 (7.7%) >0.99

CONCLUSIONS: In our experience, RCE was not inferior to MACE procedure on the point of fecal continence. We recommend

except when the patients need concomitant urinary tract reconstruction. However, in adolescent children, MACE makes it easier to administer the enema independently, the program of colonic emptying should be designed individually.

Source of Funding: None

854BODY MASS INDEX AS A PREDICTIVE VALUE FOR COMPLICATIONS ASSOCIATED WITH RECONSTRUCTIVE SURGERY IN THE MYELODYSPLASIA PATIENTBen O Donovan*, Dominic Frimberger, Christopher C Roth, Mirian Boci, Stephen D Confer, Brianna C Bright, Bradley P Kropp. Oklahoma City, OK.

INTRODUCTION AND OBJECTIVE: Myelodysplasia patients often have urologic pathology with 25-40% of these patients requiring reconstructive procedures to achieve urinary and/or fecal continence. Complications from these major reconstructive procedures range between 10 and 50%. Additionally, many of theses patients have

to an increase in body mass index (BMI). It is currently unknown whether an increase in BMI is associated with an increase in surgical complications. Herein, a report comparing BMI and patient complications is performed.

METHODS: A retrospective review of all myelodysplasia patients undergoing urinary or fecal reconstruction procedures was performed. Data for BMI and any documented complication occurring during the hospital admission or at any time during follow up was

(BMI < 85th percentile), overweight (BMI between the 85th and 95th

percentile) or obese (> 95th percentile). Statistical analysis using chi-square and Fisher’s exact test were then performed.

RESULTS: Reconstructive procedures were performed in 66 myelodysplasia patients between 1997 and 2005. 48 bladder augmentations were performed with a total of 101 stomas created. Mean follow up was 39 months. Height and weight were available for BMI calculation in 60 patients. Obesity was prevalent in our myelodysplasia patients representing 33.3% (20/60). We found a total of 53 complications

between presence of complications and weight category: incidences of complications in these categories were 40% of normal BMI, 40% of overweight and 75% of obese (p = .0380). An association between stomal stenosis and obesity was also found (p = .0373). In addition, multiple complications were more prevalent in obese patients. Of the 15 pts (25 %, 15/60) that had 2 or more complications, 66 % (10/15) occurred in the obese patients (p=.0066).

CONCLUSIONS: Myelodysplasia patients have a high incidence of obesity. Obesity is associated with a higher complication rate. Weight loss programs are highly recommended for obese myelodysplasia patients prior to and after any reconstructive surgery.

Source of Funding: None

855HEALTH RELATED QUALITY OF LIFE OUTCOMES: COMPARISON OF SLINGS WITH AND WITHOUT AUGMENTATION FOR CONTINENCE IN MYELOMENINGOCELEWarren T Snodgrass*, Richard C Adams, Amy Keefover-Hicks. Dallas, TX.

INTRODUCTION AND OBJECTIVE: Bladder neck sling with enterocystoplasty is the most commonly used procedure for

published outcomes in patients undergoing sling without augmentation

subsequent augmentation). This study compares patients undergoing sling with versus without augmentation. Health-related quality of life (HRQOL) outcomes for each were measured.

METHODS: Consecutive patients returning for routine spina

perceived changes related to prior surgery. A questionnaire using a Likert scale was completed by the family regarding HRQOL. Twenty-three children had sling/no augment and 20 underwent sling/augment. Gender, age, and ambulatory status were balanced.

RESULTS: Wilcoxin two-sample test was employed. There

and oxybutynin doses were greater {mean 15.8 mg/day vs 2.5 mg/day}

difference on only 1 of 9 questions {perceived achievement of more independence with self-care} (p=0.02) among those with augmentation, but no difference in participation in social events, physical and emotional well-being, or perceived improved health after surgery. There were no differences in achieved continence between the two groups

CONCLUSIONS: As expected, patients undergoing

However, continence was not improved with augmentation. Perceived HRQOL changes differed in only one area in these two sample groups. These results further question need for routine enterocystoplasty with sling procedures, while providing families and surgeons evidence-based information to consider in decision making.

Source of Funding: None

856DOES EXTERNAL URETHRAL SPHINCTER DILATION COMPROMISE CONTINENCE IN HIGH-RISK MYELOMENINGOCELE PATIENTS?Diana K Bowen*, Julian Wan, David A Bloom, John M Park. Ann Arbor, MI.

INTRODUCTION AND OBJECTIVE: The prognostic