Retrograde continence enema in children with spina bifida: Not as effective as first thought.

AIM: The aim of the study is to investigate the effectiveness of Peristeen retrograde continence enema (RCE) in the management of faecal incontinence in children with spina bifida. METHODS: We identified a homogenous group of spina bifida patients in whom RCE was initiated (Jan 2006-July 2013). Confidential assessments included (i) Fecal Incontinence Quality Of Life (FIQOL), (ii) St Marks Faecal Incontinence score, (iii) Cleveland Clinic Constipation score and (iv) Neurogenic Bowel Dysfunction score. RESULTS: Of 20 patients, 11 (mean age 14.5 ± 5.3 years) were male. Of 20 patients, nine were still using RCE (mean follow-up 4.1 years). Three patients ceased RCE within 10 days, six after 4-12 months and two after 36-48 months. Reasons for cessation included balloon difficulties (n = 4), procedure deemed too difficult (n = 4) and pain (n = 3). There were no differences between the groups in length of training time for technique, instillate fluid/volume used and time taken to perform RCE. There were no differences between the groups for quality of life, faecal incontinence or constipation scores. CONCLUSIONS: We demonstrated a high rate of cessation with RCE in patients with spina bifida. This could not be explained by associated conditions, or by enema-related parameters. One possible explanation is the lack of ongoing outpatient support for the children and their families.

Nocturnal polyuria in type 2 diabetes: a symptom of obstructive sleep apnea.

PURPOSE: Polyuria and nocturia in individuals with type 2 diabetes may be due to obstructive sleep apnea (OSA), a recently recognized etiology of excess nighttime urine production. This exploratory study examined the relationships among glucose control, OSA, and nocturnal urine production. METHODS: A sample of community-dwelling older adults (20 nondiabetic subjects and 10 poorly controlled type 2 diabetes subjects) was recruited based on self-report of nocturia more than twice per night. Participants were monitored on a metabolic research unit for 24 hours to track intake/output, collect blood and urine samples, and conduct an overnight polysomnography sleep study. RESULTS: None of the subjects had fasting serum glucose levels above the renal threshold. OSA was found in 65% of subjects. Those with moderate/severe OSA had significantly greater overnight urine production than subjects without OSA. Subjects with type 2 diabetes and moderate/severe OSA had the highest nocturnal urine production. CONCLUSIONS: The high incidence of undetected OSA in subjects with type 2 diabetes with nocturia suggests that nocturia, OSA, and type 2 diabetes frequently coexist and may be interrelated.