Use of polydimethylsiloxane for endoscopic treatment of neurogenic urinaryincontinence in children

Purpose: We report on the injection of polydimethylsiloxane for endoscopic treatment of urinary incontinence in children with neurogenic bladder and d etermine the optimal criteria for patient selection. Materials and Methods: We have treated 17 boys and 16 girls since 1995. The etiology of incontinence was spina bifida in 24 cases. Previous surgery wa s performed in 18 patients, including bladder neck reconstruction in 15 and bladder augmentation in 9. Mean patient age at injection was 13 years (ran ge 7 to 17). We administered 1, 2 and 3 injections in 21, 11 and 1 patients , respectively. Mean volume ateach injection was 3.2 cc. Mean interval betw een injections was 6 months (range 3 to 15). In all cases injection was don e transurethrally. Results: Followup ranged from 6 to 41 months (median 16). A total of 11 pat ients (33.3%) are dry (continence for greater than 4 hours and no urinary p ad use during the day) and 8 (24.2%) are improved (continence for 2 to 3 ho urs and minimal pad use). Results are poor in 14 cases. Overall previous bl adder neck surgery or preoperative detrusor hyperactivity did not influence results. Good results were mainly associated with female gender (47.4% of girls versus 10.5% of boys achieved cure). Conclusions: Injection of polydimethlylsiloxane at the bladder neck resulte d in continence in 33% of neurogenic bladder cases. Better results occurred in girls and injection did not compromise other surgical procedures. Polyd imethylsiloxane seems more suitable than bovine collagen due to potential p roblems with biological product use.