The new Malone antegrade continence enema automatic instillation device allows independence and decreases flush times.

PURPOSE: The Malone antegrade continence enema procedure has changed the lives of many school-aged children who would otherwise be in diapers. Unfortunately, our current procedures to flush the Malone antegrade continence enema are difficult to accomplish independently and require an extensive time commitment. In this study we confirm that a new device, the ACE Malone automatic instillation device (ACE-MAID) is safe and effective, will decrease the time it takes to perform the flush and will increase independence. MATERIALS AND METHODS: Nine patients were prospectively enrolled for a 1-year study. Patient age ranged from 4 to 16 years, and diagnoses included spina bifida (3 cases), imperforate anus (4) and infantile meningitis (1). The study consisted of initial and followup questionnaires, an "ACE-O-Gram," quality assurance testing of the ACE-MAID and an objective observation of current flushing technique. RESULTS: The average objective start to finish flush time decreased from 45 minutes initially to 31 minutes using the ACE-MAID. Children who initially had more than 1 accident per month had a decrease in the number of stool accidents. When asked to compare the ACE-MAID device to the previous form of flushing 100% of patients stated that it was better. When asked if they would use the pump when the study was over 100% reported yes. CONCLUSIONS: The new ACE-MAID proved safe and effective, decreased flush times, may decrease stool accidents and facilitates independence for children treated with a MACE procedure.

Obstructive uropathy: considerations for the nephrology nurse.

Obstructive uropathy is the cause of renal failure in 16.2% of pediatric patients who undergo renal transplantation, 12.9% of those on dialysis, and 23.1% of those with chronic renal insufficiency, according to the annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Successfully caring for patients with obstructive uropathy requires an understanding of the various congenital anomalies that create obstructive uropathy, the urological interventions used to treat them, management of the patient, and the nursing care required.