Long-term effects of endoscopic injection of dextranomer/hyaluronic acid based implants for treatment of urinary incontinence in children with neurogenic bladder.

PURPOSE

We prospectively evaluated the efficacy of dextranomer/hyaluronic acid based implants for the endoscopic treatment of neurogenic urinary incontinence.

MATERIALS AND METHODS

We prospectively studied patients undergoing endoscopic injection of dextranomer/hyaluronic acid for structural incontinence beginning in October 1997. Preoperative evaluation consisted of medical history, incontinence charts, urine culture, urinary tract ultrasound and videourodynamics, which were repeated regularly during followup. At each evaluation patients were classified as cured or significantly improved (treatment success), or not significantly improved (treatment failure). Followup ranged from 1 to 13 years (mean 7.4).

RESULTS

A total of 48 patients 5 to 20 years old with congenital (45 patients) or acquired (3) neurogenic bladder suffering from severe sphincteric incompetence were included. Of the patients 30 underwent 1, 13 underwent 2 and 5 underwent 3 treatment sessions. Mean injected volume was 4.6 ml per session. Five patients had previously undergone bladder neck surgery. Two patients lost to followup in the short term were classified as treatment failures. Of the patients 45 had more than 2 years of followup, of whom 19 (39.6%) were dry, 6 (12.5%) were significantly improved and 23 (47.9%) had no significant improvement observed. Female patients achieved a significantly higher success rate than males (p = 0.05). No significant clinical or urodynamic criterion was predictive of success or failure. Posttreatment bladder deterioration developed in 10 cases (7 successes and 3 failures), which were managed by bladder augmentation.

CONCLUSIONS

Endoscopic treatment of neurogenic urinary sphincter insufficiency with dextranomer/hyaluronic acid is effective in half of the patients. Recurrence of incontinence after 1 year is mainly a sign of bladder deterioration.