Hypothesis / aims of study
In patients with spina bifida(SB) or spinal cord injury(SCI) continence management must be addressed to neurogenic bladder as well as bowel dysfunction. Transanal irrigation (TAI) has been succesfully reintroduced for the management of bowel dysfunction, changing the approach, actually mostly conservative respect to the past, when Malone surgical procedure was very popular. TAI effectiveness has been related to a correct training and a carefull follow-up, very important especially in adolescents, when low adherence to chronic treatment is very common to observe. Aim of our study is to investigate clinical effectiveness and patient experience of transanal irrigation (TAI) using electronic device.
Study design, materials and methods
Retrospective study in pediatric patients who used a Navina TAI smart system has been performed, collecting baseline characteristics and data on treatment success at 1,6,12 months follow-up. Only patients aged 3-18 years have been considered, all with neurogenic bowel dysfunction and a minimum follow-up of 12 months. TAI training have been performed in a 3 days module, where first irrigation have been always performed into the Hospital by our specialist nurse team, the second one by the patient/caregiver , under control by a specialist continence care.Treatment success was defined as bowel emptying at least 3 times/week, with reduced time for evacuation, less than 1 episode of fecal incontinence/week. Patients have been evaluated after a 1 year minimum follow-up using a specific 10 domains questionnaire on bowel function, satisfaction,QoL . A score 0-10 was used , where 0 as reported as very poor results. TAI and the study has been performed in all , according a defined protocol approved by our Hospital Committee, including data management, after a written consent was signed. Data were evaluated by statistician, using SPMMS Microsoft excel program.
Results
From January 2017 to december 2022, 18 patients, aged 4-19 years, have beeen treated with TAI Navina Smart System, 13 of them aged 4-18 years have been included. TAI has been performed for 2,5- 5 years, mean 3,8 years. No serious adverse effects have been recorded. 3 patients reported to stop TAI because not satisfied about clinical results, or for problems related to irrigation. Drop out was 23% in our group. Up to now 10 patients are in treatment and follow-up: treatment success rate improved in all respect to baseline: 80% higly satisfied and 70% reporting an high effectiveness of bowel function. Increased independence has been reported by 70%, complete adherence to the treatment has been reported in 50%.
Interpretation of results
In neurogenic bowel management, the role of TAI is well defined in a step pyramid of care, where the use of conservative medical treatment including dietary advice, laxatives, suppositories or enema are usefull to improve results. In paediatrics population TAI is presenting an increasing use due to a high rate of success both in clinical as in QoL, where untill nose all previous pediatric experience are reported using manual devices.Neverthless the dropout rate is still high, especially in adolescents were low adherence to long-term treatment is common to observe. In our opinion is very important to offer a careful follow-up to the patients and to the caregiver in order to reduced dropout. Patient’s motivation and satisfaction is a critical point because low adherence in many cases is not related to side effects or to technical problem during irrigation or low effectiveness. For this reason different systems for irrigation , manual or electronic, as different type of catheters or probes, coud be useful in order to individualize TAI, as is performed for clean intermittent catheterization in neurogenic bladder, where the choice of catheter is commonly patient's related.