ESPU Congress 2018 - Abstract Book

155 11–14 APRIL, 2018, HELSINKI, FINLAND 17:08–17:11 S20-5 (PP) ANTEGRADE CONTINENCE ENEMA (ACE) CONDUITS FOR FECAL INCONTINENCE MAY IMPROVE LOWER URINARY TRACT SYMPTOMS IN MALES WITH SEVERE ANORECTAL MALFORMATIONS Kristiina KYRKLUND, Seppo TASKINEN, Eija MÄKELÄ, Risto J RINTALA and Mikko P PAKARINEN Hospital for Children and Adolescents, University of Helsinki, Pediatric Surgery, Helsinki, FINLAND PURPOSE Rectourethral fistula (RUF) is a rare and severe type of anorectal malformation (ARM) associated with impaired bowel function and lower urinary tract symptoms (LUTS). We investigated whether ACE conduits for achieving social fecal continence also secondarily improves LUTS. MATERIAL AND METHODS The records of all males treated for RUF with posterior sagittal anorectoplasty between 1983–2006 and requiring ACE for poor fecal control were retrospectively reviewed. Patients with major sacral anomalies (<3 segments remaining) or cognitive impairment were excluded. RESULTS Of 43 males with RUF, 15 (35 %; median age 21 (range,11–32) years; 2 bulbar, 8 prostatic, 4 blad- derneck fistulas) had undergone ACE at a median age of 8 (range,4,5–22) years. None were lost to follow-up. There were 3 cases of grade III VUR (20 %), 1 horseshoe kidney, 1 ectopic ureter requiring neoimplantation and 1 hypospadias repair. Before ACE, 53 % (n=8) had daily daytime stress or urge urinary incontinence (UI), 27 %(n=4) reported bedwetting and 27 % (n=4;3 bladder- neck RUF) still wore diapers. ¾ patients with daily UI had detrusor overactivity on urodynamics but normal bladder capacity; 1 also had obstructive bladder emptying requiring intermittent catheteriza- tion. In 0,2–2 years following ACE, social continence for stool was achieved in 93 % (14/15) and contemporaneous improvement in LUTs was observed in 7/8 cases so that patients discontinued diapers and were daytime and night-time dry. One patient with bladderneck fistula and obstructive symptoms continued with intermittent catheterization and anticholinergics beyond 2 years after an ACE. No patients required further reconstructive urologic surgery. CONCLUSIONS Improving bowel function with ACE may secondarily reduce LUTS and improve urinary continence in males with severe ARMs. 17:11–17:20 Discussion