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

Purpose: We report on the use of polydimethylsiloxane for endoscopic treatment 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 bifida in 35 cases. Previous surgery had been performed on 24 patients, including bladder neck reconstruction with (17) or without bladder augmentation. Mean patient age at injection was 13 years (range 7 to 17). A single transurethral injection was given in 23 cases, 2 in 17 and 3 or more in 4. Mean volume at each injection was 3.5 cc and for each patient the total volume injected 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 15 (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 hyperactivity influenced the results, as the best results were achieved in females 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 injection (until 36 months for older patients) and after the last of 2 injections. 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 girls with a stable bladder. Results deteriorated in the first 12 months, of followup. No more than 3 injections are advised if a satisfactory result is not achieved.