Table 1.
Study characterization, scales used, follow up, and main results.
| Author, year | Country | Study design | Sample | Objective | Validated scales/scores | Follow up | Outcomes |
|---|---|---|---|---|---|---|---|
| Walker and Webster, 198924 | United Kingdom | Descriptive Single center |
10 SB Age: 4-17 years |
- | - | 4-30 months | 70% FI improvement |
| Liptak and Revel, 199225 | USA | Quasi-experimental pre-test/post-test Single center |
30 MMC Age: 3-19 years |
To evaluate the catheter for continence enema created by Shandling and Gilmour. | Satisfaction scale (0-4) |
T1=18 months T2=30 months |
55% constipation for 20% in T1 and 15% in T2 FI from 72% to 29% in T1 and 6% in T2 Satisfaction degree from 1.1 to 2.8 in T1 and 3.3 in T2 Reduced the need for diapers from 88% to 73% in T1 and 72% in T2 |
| Blair, 199226 | United Kingdom | Quasi-experimental pre-test/post-test Single center |
19 MMC Age: 3-16 years |
Presenting patients who went through a 1-year study in the Fecal Incontinence Clinic at the British Columbia Children's Hospital. | Satisfaction scale (0-5) |
12 months | FI improvement in 87% |
| De Kort, 199727 | The Netherlands | Quasi-experimental pre-test/post-test Single center |
83 SB Age: 1-17 years |
To evaluate whether colonic enema irrigation influences urodynamic characteristics of SB patients. | - | - | There was no significant difference in urodynamics. |
| Mattsson and Gladh, 200628 | Switzerland | Quasi-experimental pre-test/post-test Single center |
40 MMC Age: from 10 months to 11 years |
To evaluate transanal irrigation with clean tap water with no salt in children with MMC and neurogenic bowel disorders. | - | 18 months | 100% constipation improvement Improvements in the wellbeing of the child, better appetite, less stomach ache and headache complaints. (36/40) 95% depended on their parents |
| Vande Velde, 200729 | Belgium | Cross-sectional study Single center |
80 MMC Age: 5-18 years |
To evaluate the results of a stratified approach to reach fecal pseudocontinence in MMC patients. | - | - | Pseudocontinence achieved in 69% |
| Ausili, 201030 | Italy | Quasi-experimental pre-test/post-test Single center |
60 SB Age: 6-17 years |
To evaluate whether the TAI can be a safe and effective alternative approach to manage pediatric neurogenic constipation in children with MMC and to improve the intestinal habits and QoL of patients and their families. | NBD Score Satisfaction scale (0 to 10) |
3 months | Constipation improved in 60% FI improved in 75% NBD score from 17.5 to 8.5 (p < 0.001) Independence - 26.7% Diminution in E. coli urinary tract infections |
| Vande Velde, 201331 | Belgium | Prospective cohort Single center |
25 SB Age: 5-17 years |
To study the use of colon enemas to reach fecal pseudocontinence in SB patients, determining variables associated with the success. | - | Mean of 5 years old | Pseudocontinence in 76% Social fecal continence in 88% Independence - 17% |
| Neel, 201032 | Saudi Arabia | Quasi- experimental pre-test/post-test | 13 SB Age: 5.3 years (median) |
To evaluate the efficacy and durability of combined intradetrusor botulinum-A toxin and endoscopic treatment for vesicoureteral reflux with anal irrigation as a total endoscopic and anal irrigation management approach. | - | 12 months | 10 out of 13 achieved fecal continence by having TAI applied for a mean of twice a week and could stop wearing diapers. |
| Donlau, 201333 | Sweden | Quasi- experimental pre-test/post-test | 22 SB Age: 3-17.2 years |
To evaluate a step-by-step method to determine goals for self-care training in bathroom activities for children with MMC. | GAS | - | The group that trained in TAI (7 patients), at first, has a median score of 30 (m32.1, range 28–41); after training, the score became 49 (m 44.6, range 32–54), also showing significant improvement (compared mean p=0.02). |
| Choi, 201334 | South Korea | Quasi-experimental pre-test/post-test Single center |
53 SB Age: 3 to 13.8 years |
To evaluate the clinical efficacy of a bowel management program in the QoL of SB children and their caregivers. | Bristol Scale | 3 to 7 months | Success in 81.1% (FI and constipation) |
| Choi, 201535 | South Korea | Quasi-experimental pre-test/post-test Single center |
44 SB Age: 3-13.8 years |
To evaluate long-term clinical efficacy of TAI and its effects on the QoL of SB children and their caregivers. | FIQL | T1=3 months T2=3 years |
Pseudocontinece from 35.1 to 91.9% at T1 and 89.2% at T2 Lower use of diapers, 1.6 at T1 and 0.2 at T2 FI improvement of 7.3 at T1 and 0.4 at T2 TAI satisfaction went from 8 (T1) to 10 (T2) |
| King, 201736 | Australia | Cross-sectional study Single center |
20 SB Age: 14.5 years (median) |
To investigate the efficacy of Peristeen® continence retrograde irrigation in children with SB. | FIQL St. Marks FI Index Cleveland Clinic Constipation Index NBD Score |
1-8 years | FI and pseudocontinence improved in 8/9 patients (no significant difference) |
| Ambartsumyan and Rodriguez, 20187 | USA | Narrative Literature Revision | - | To review a step-by-step approach for bowel management in children with SB, and the challenges related with the tt options proposed. | Cites: Pediatric NBD Score Adolescent Fecal Incontinence and Constipation Symptom Index |
6 months | Success rate of 66-87.5%; QoL increase Constipation reduction from 92.7% to 41.5%; FI from 39.9% to 9.8%. and flatulent incontinence from 31.7% to 10%. NDB score reductiona |
| Ausili, 201837 | Italy | Quasi-experimental time series Multicentric |
38 SB Age: 6-17 years |
To evaluate the short-to-medium term efficiency of TAI and its effect on the quality of life of children with SB and anorectal malformations. | CHQ-PF50 for the parents and SF36 for patients from 12 to 17 years old Bristol Scale |
Minimum of 24 months | Constipation improved in 93% (T0) FI improved from 39% (T0) to 11% (T1), and then to 17% (T2) the CHQ-PF50 showed QoL improvement SF36 showed improvement in 9 variables |
| Alhazmi, 201938 | Saudi Arabia | Cross-sectional study Single center |
109 MMC Age: 5-18 years |
To evaluate the efficacy and long-term satisfaction of TAI (Peristeen®) in children with MMC who did not respond to the FI conservative tt. | - | 48 months | 90.4% improvement in FI |
| Kelly, 201939 | USA | Narrative Literature Revision | 22 SB - |
Providing updated information for physicians comparing techniques (TAI, cecostomy, and Malone), which have relatively high fecal continence and satisfaction success rates. | - | 4 years | Mean rate of continence with TAI 77.7% (53-97% interval); Constipation improvement: 78% (interval from 53-97%) General improvement of symptoms: 84% (60-100% interval)a |
| Kelly, 202040 | USA | Cross-sectional study Multicentric |
380 SB Age: 5-19 years |
To determine the continence variation and its ability to carry out tt according with the modality and the characteristics of people with MMC and IN. | - | - | Continence rate of 57% with the cone - children Continence rate of 80% with Peristeen® 80% - adolescents 9.8% of children and 36.5% of adolescents were independent using the conea |
| Gibbons, 202041 | Ireland | Case–control | 48 SB controls Age: 3-16 years |
To compare bowel function-related quality of life in children with SB with a control group of their peers to better understand the impact of bowel management and evaluate whether QoL differs with varying bowel management strategies | NBD Score | - | There was no QoL difference between bowel management strategies, including the group with no treatment (p = 0.203). Despite active bowel management, the NBD score was lower in the SB group. |
| Milivojevic, 202042 | Servia | Prospective cohort | 39 SB Age: mean 9.5 ± 3.7 years |
To examine the effects of bowel management on urodynamic findings in SB children with detrusor overactivity and detrusor sphincter dyssynergia. | Roma III | 12 months | 87.2% gained complete control over constipation, 71.8% gained complete control over FI, transversal rectum diameter in echosonography <3, and absence of encopresis (p < 0.001). Intestinal control led to significant improvement in urodynamic parameters (p < 0.001). |
| Van Renterghem, 202143 | Belgium | Quasi-experimental pre-test/post-test Single center |
14 SB Age:3-18 years |
Comparing 2 TAI systems in children with congenital diseases. | Bristol Scale; Satisfaction Scale (0-10) |
Minimum of 2 weeks with the cone and 2 weeks with Peristeen® | Use of Peristeen®: 5/7 pseudoconetinent and 2/7 socially continent; Mean satisfaction with the device 8 Cone use: 17 pseudocontinent; 4/7 socially continent; and 2 incontinent. Mean satisfaction 8a |
| Pinheiro, 202123 | Brazil | Quasi-experimental Pre-test/post-test Single center |
19 MMC Age:3-18 years |
To evaluate TAI viability using the cone; impact on elimination function and on the QoL of MMC and FI patients, and in the family QoL. | CHQ-PF50 (QV) Wexner FI score |
12 months | The domains with the greatest significance and positive impact on QoLRH was “health alteration” and “global health”, after TAIa |
| Furuta, 202144 | Japan | Quasi-experimental Pre-test/Post-test with non-equivalent control group Single center |
16 SB Age: 6-17 years |
To investigate changes in the bowel microbiota after TAI in patients with SB. |
Bristol Scale NBD Score |
3 months | Significant reduction of Faecalibacterium and Blautia, with a significant increase of Bacteroides and Roseburia (associated with immune system improvement). Constipation improvements. |
a
We could not isolate data on the pediatric population in the other outcomes.
SB, spina bífida; FI, fecal incontinence; MMC, myelomeningocele; QoLRH, quality of life as related to health; TT, treatment; FIQL, the fecal incontinence quality of life scale of life; NBD Score, neurogenic bowel dysfunction score; CHQ-PF50, child health questionnaire; GAS, goal attainment scale.