Christensen et al. 2000; Denmark
Downs & Black = 17
Retrospective interviews and case series
N=29; 19 SCI patients

Population:
1) Enema continence catheter: 21 patients, including 15 who are SCI; 11 women and 10 men; Age: mean 39.9, range 7-72 years; Level and type of injury: 3 supraconal SCIs (T2 incomplete, T4 complete, T11 complete), 12 conal or cauda equina injuries (all incomplete) ; mean follow-up 16 months, range 1-51
2) Malone antegrade continence enema: 8 patients, including 4 who had a SCI; 5 females and 3 males; Age: mean 32.8 years, range 15-66; 2 supraconal SCIs (C5-6 and T2, incomplete); mean follow-up 38 months, range 4-77
Treatment: Enema continence catheter (ECC) vs. Malone antegrade continence enema (MACE)
Outcome Measures: colorectal function, practical procedure, impact on daily living and QOL, general satisfaction

1. Overall success with the ECC was found in 12 of 21 patients (57%). In patients with fecal incontinence, the ECC was successful in 8/11 (73%), while 4/10 (40%) with constipation were successfully treated.
2. Overall success with the MACE was found in 7/8 (87%) patients.
3. Successful treatment with the ECC or the MACE was followed by significant improvement in quality of life
4. Authors view the ECC as a simple therapeutic method in severe neurogenic colorectal dysfunction. If the ECC fails, the MACE, as a minor and reversible operation, is a suitable alternative to more extensive procedures.

Teichman et al. 2003; USA
Downs & Black = 15
Retrospective review
N=6; 3 SCI patients

Population: 3 males; Age: mean 36, range 29-47; Level of injury: T5 complete, C6 complete, C7 incomplete; Mean follow-up 4.5 years
Treatment: Malone antegrade continence enema (MACE)
Outcome Measures: Bowel incontinence; subjective patient satisfaction

1. 2 out of 3 SCI subjects experienced fecal incontinence prior to the operation. Post-operatively, both these subjects became continent
2. All 3 SCI subjects were satisfied with their outcomes and rated their quality of life higher after their MACE procedure compared with beforehand.
3. All 3 SCI subjects experienced prolonged toileting pre-operatively as a result of bowel status. Post-operatively, all subjects had a reduction in their toileting times such that it was no longer an issue.

Worsoe et al. 2008
Denmark
Downs & Black =14
Case Series
N = 80

Population: 80 subjects, 64 female, 16 male, mean age 51 (range 17-84)
Treatment: Antegrade colonic enema (ACE), or ACE combined with colostomy
Outcome Measures: A 44-item questionnaire, including whether the patient is still using ACE and if not, why; functional results and side effects of ACE; overall satisfaction with bowel function and quality of life; success of treatment, defined as subjects still using ACE or symptoms resolved because of ACE

1. 69 subjects were available for follow up, of whom 43 were still using ACE and 8 had their symptoms resolved; ACE success rate was 74%
2. Complications occurred in 30 patients, including wound infection, urinary tract infection, stenosis of the appendicostomy, and problems with catheterization
3. 34 of the 43 patients still using ACE were satisfied or very satisfied with the results; on a 0-100 scale, mean values for subjective bowel function was 12 before and improved to 81 after ACE

Teichman et al. 1998; USA
Downs & Black = 8
Retrospective review
N=7; 4 SCI patients

Population: 4 males; Age: mean 32.5, range 22-47; Level of injury: C6 complete, C7 incomplete, T5 complete, C6; Mean follow-up 11 months
Treatment: Malone antegrade continence enema
Outcome Measures: Number of fecal incontinence episodes per week; Time for evacuation; bowel management attempted

1. 3 out of 4 SCI subjects experienced fecal incontinence prior to the operation. All became continent as a result of the operation.
2. Pre-operatively, SCI subjects’ toileting times ranged from 1-4 hours as a result of their bowel status. Post-operatively, these subjects were able to evacuate within 30 minutes or less.
3. Autonomic dysreflexia secondary to neurogenic bowel was resolved post-operatively.