Dextranomer/hyaluronic acid bladder neck injection for persistent outlet incompetency after sling procedures in children with neurogenic urinary incontinence

Journal of Pediatric Urology
Daniel DaJustaWarren Snodgrass

Abstract

We report outcomes after dextranomer/hyaluronic acid (Dx/HA) bladder neck injection for persistent outlet incompetency despite prior sling or Leadbetter/Mitchell bladder neck revision plus sling (LMS) in children with neurogenic urinary incontinence. Consecutive patients with outlet incompetency after sling (n = 17) or LMS (n = 9) underwent a maximum of 2 Dx/HA injections. Antegrade and/or retrograde endoscopy was used to access the bladder outlet, and injection done in quadrants to achieve visual mucosal coaptation. Outcomes were described as either "dry", not requiring pads, or "wet". There were 24 children with follow-up after injection, of which 9 (38%) were initially dry and 15 (62%) remained wet. Of the 9 dry patients, 4 had recurrent incontinence at a mean of 16 months while 5 remained dry at a mean of 27 months. Second injections were done in a total of 14 children, with 1 dry at 39 months. Of all 24 children, up to 2 injections resulted in 6 (25%) dry patients, while the remainder was wet at last follow-up. Gender, initial outlet surgery, pre-injection pad use, injection technique, and volume injected did not predict outcomes. Dx/HA bladder neck injection resulted in dryness in 25% of patients in this series after fail...Continue Reading

References

Dec 13, 2006·The Journal of Urology·David M KitchensCurtis A Sheldon
Jan 16, 2007·The Journal of Urology·James Higham-KesslerAnthony A Caldamone
Aug 24, 2010·The Journal of Urology·Warren Snodgrass, Theodore Barber

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Citations

Dec 3, 2014·The Urologic Clinics of North America·Patricio C Gargollo
Jul 15, 2015·The Journal of Urology·Gwen M GrimsbyMicah A Jacobs
Mar 11, 2016·F1000Research·Roberto I Lopes, Armando Lorenzo
Apr 16, 2019·Frontiers in Pediatrics·Barbara M LudwikowskiRicardo González
Apr 21, 2016·Current Opinion in Urology·Alonso Carrasco, Vijaya M Vemulakonda

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