Endoscopic treatment of urinary incontinence: Long-term evaluation of the results

Purpose: We report on the use of polydimethylsiloxane for endoscopic treatm ent of urinary incontinence in children with neurogenic bladder and discuss our results to determine optimal criteria for patient selection. Materials and Methods: A total of 44 children (19 males) have been treated endoscopically for urinary incontinence since 1995. Etiology was spina bifi da in 35 cases. Previous surgery had been performed on 24 patients, includi ng bladder neck reconstruction with (17) or without bladder augmentation. M ean patient age at injection was 13 years (range 7 to 17). A single transur ethral injection was given in 23 cases, 2 in 17 and 3 or more in 4. Mean vo lume at each injection was 3.5 cc and for each patient the total volume inj ected was 5.7 cc. Mean delay between 2 injections was 6 months (range 3 to 15). Results: Followup ranged from 6 to 53 months (median 28). Of the patients 1 5 (34%) are dry (continent greater than 4 hours, no urinary pad during the day), 11 (25%) are improved (continent 2 to 3 hours, occasional pad) and 18 had poor results. In the entire series only gender and preoperative hypera ctivity influenced the results, as the best results were achieved in female s with a stable bladder (44% of girls versus 21% of boys were cured). Good results persisted at 12-month followup in patients treated with only 1 inje ction (until 36 months for older patients) and after the last of 2 injectio ns. Of the patients treated with 3 or more injections 1 was dry at 12-month followup and treatment failed in 3. Conclusions: Injection of polydimethylsiloxane at the bladder neck achieved continence in 34% of neurogenic bladder cases. Results were better in girl s with a stable bladder. Results deteriorated in the first 12 months, of fo llowup. No more than 3 injections are advised if a satisfactory result is n ot achieved.