Paediatric Surgery (Ukraine). 2026. 2(91): 142-146. doi: 10.15574/PS.2026.2(91).142146
Dihtiar V. A.¹, Vernihora D. H.^1,2, Gladkiy O. P.², Boyko M. V.², Obertinskyi A. V.², Ostrovska O. A.²
¹Dnipro State Medical University, Ukraine
²Regional Medical Center for Family Health, Dnipro, Ukraine

For citation: Dihtiar VA, Vernihora DH, Gladkiy OP, Boyko MV, Obertinskyi AV, Ostrovska OA. (2026). A clinical case of combined surgical treatment with Mitrofanoff and MACE procedures in a child with persistent urinary and fecal incontinence. Paediatric Surgery (Ukraine). 2(91): 142-146. doi: 10.15574/PS.2026.2(91).142146.
Article received: Mar 12, 2026. Accepted for publication: Jun 15, 2026.

Myelomeningocele is frequently associated with neurogenic bladder and bowel dysfunction. Combined urinary and fecal incontinence limits the child's independence and social adaptation. When pharmacotherapy, catheterization, and a bowel management program provide insufficient control, individually tailored reconstructive surgery may be required.
Aim – to analyze a case of combined surgical intervention involving appendicovesicostomy (the Mitrofanoff procedure) and antegrade colonic irrigation (MACE – Malone Antegrade Continence Enema) in a child with incontinence associated with myelomeningocele, based on a clinical case.
Clinical case. A 6-year-old patient with myelomeningocele and a lack of urinary and fecal control underwent urodynamic testing, ultrasonography, voiding cystourethrography, computed tomography, and renal scintigraphy. After oxybutynin treatment and two courses of intradetrusor botulinum toxin injections, the bladder volume at onset of leakage increased from 80 to 150 mL, yet urinary continence was not achieved; fecal soiling persisted despite enemas and laxatives. Surgery included Cohen ureteral reimplantation, Young-Dees-Leadbetter bladder neck reconstruction, appendicovesicostomy, and creation of a cecostomy from the cecal dome for MACE. One month postoperatively, the patient started self-catheterization every 3 hours and daily morning irrigation with 700 mL of 0.9% sodium chloride solution; bowel evacuation took 30-40 minutes. Follow-up observations showed complete resolution of urinary leakage and fecal soiling and improved social adaptation.
Conclusions. In this case, combined reconstruction ensured controlled bladder and bowel emptying and was accompanied by an improvement in the patient's daily functioning. The outcome reflects the combined effect of the comprehensive surgical treatment regular care. Long-term follow-up and objective assessment of bladder and upper urinary tract function are needed to evaluate its long-term efficacy and safety.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the patient's parents.
The authors declare no conflict of interest.
Keywords: myelomeningocele, neurogenic bladder, incontinence, Malone Antegrade Continence Enema (MACE), Mitrofanoff, pediatric surgery.

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