The Malone antegrade continence enema (MACE) procedure remains an effective tool in providing independence to pediatric patients with refractory constipation. Unfortunately, MACE stomal stenosis (SS) continues to be a frustrating complication. A recent study published in the Journal of Pediatric Urology aimed to perform a retrospective risk analysis of the pre-operative factors associated with postoperative stomal stenosis. This review included 39 consecutive patients treated with MACE by a single surgeon. Collected data included the type of channel construction, stoma site, pre-operative body mass index (BMI) z-score, pre-operative diagnosis, and development of SS. It was observed that stomal stenosis developed in 49% patients with an average follow-up of 4.7 years. Ninety percent of patients had a diagnosis of myelomeningocele, and there was no significant difference in gender distribution. Meanwhile, the distribution types of MACE efferent limbs consisted of appendicocecostomy in 51%; cecal-wall flap in 41%; and ileocecostomy in 8% patients. Additionally, neither the type of efferent limb, nor stomal location were significant predictors of postoperative SS. Whereas pre-operative obesity (BMI ≥95%) was found to be a significant risk of SS. Hence, it was concluded that neither a cecal wall flap nor the stomal site location contributed to SS. However, obesity was the only identified statistically significant risk factor that led to SS.