Endoscopic treatment of urinary incontinence in pediatric patients: 2-year experience with dextranomer/hyaluronic acid copolymer

Purpose: We investigated the effectiveness of dextranomer/hyaluronic acid copolymer (dextranomer microspheres in sodium hyaluronan solution) as a treatment for urinary incontinence due to sphincter incompetence in children and adolescents. Materials and Methods: Patients with urinary incontinence due to neurogenic and structural causes were given a transurethral injection of dextranomer/hyaluronic acid copolymer to increase bladder outlet resistance. Patients were assessed at 1, 3, 6, 12 and 24 months after injection using a validated questionnaire, 1-hour pad test, ultrasonography, cystography and cystometry. Patients who remained incontinent were offered repeat injections of dextranomer/hyaluronic acid copolymer up to a maximum of 3 injections. Results: A total of 16 patients 8 to 22 years old were treated with dextranomer/hyaluronic acid copolymer, including 3 with neurogenic bladder, 8 with bladder exstrophy after 3-stage reconstruction, 4 with penopubic epispadias and 1 with urogenital sinus. Mean volume injected was 2.8 ml. (range 1.8 to 4.0) and mean number of injections received was 2.3 per patient. Dry time interval increased by 43 minutes (p <0.05.) and functional bladder capacity increased by 34 ml. (p <0.05) at 6 months after treatment compared with pretreatment values. Improvement in both parameters was maintained at 12 months. At 6 and 12 months of followup 12 (75%) and 8 (50%) patients reported improvements in daytime and nighttime dryness, respectively. A slight decrease in continence parameters was observed in the 13 patients who completed the 24-month followup. No adverse events were reported and no upper urinary tract deterioration was observed as a consequence of endoscopic treatment within the 2-year followup period. Conclusions: Use of dextranomer/hyaluronic acid copolymer as a bulking agent to increase bladder outlet resistance improves symptoms in children and adolescents with incontinence of neurogenic and nonneurogenic origin.