Injectable polydimethylsiloxane for treating incontinence in children with the exstrophy‐epispadias complex: long‐term results

Abstract

In this section authors from the UK describe their experience with plastic injections for treating incontinence in children with the exstrophy‐epispadias complex, finding that in the long term the success rate was reasonable, although the injections often needed to be repeated. Authors from Brazil present an analysis of anomalies of the epididymis and processus vaginalis in human fetuses, and in patients with cryptorchidism treated and untreated with hCG. OBJECTIVE To present our experience with the use of injectable polydimethylsiloxane (MacroplastiqueTM, Uroplasty, Minneapolis, MI, USA) for treating incontinence in children with the exstrophy‐epispadias complex (EEC), as incontinence continues to be a challenging problem in such children, and although the primary management of EEC has developed over the last few decades, with early closure and reconstruction of the penis, achieving satisfactory continence status remains elusive. PATIENTS AND METHODS We retrospectively reviewed the hospital records of 52 patients (41 boys and 11 girls, mean age at first injection 6.6 years, range 3.6–16.7) with EEC who had injections with Macroplastique between January 1991 and February 2004; 34 had bladder exstrophy and 18 primary epispadias. For this study we defined success as complete dryness with no use of pads or nappies. Improvement was defined as being occasionally wet but with dry intervals lasting ≥ 4 h. RESULTS The mean (range) follow‐up was 4.6 (0.5–9) years. Twenty patients had one injection, 10 had two, 13 had three, six had four, two had six and one had seven injections. In most patients a maximum of three injections predicted the outcome. The injection of Macroplastique was successful in nine patients (17%; with an annual follow‐up, two at 1–2 years, three at 2–5 years and four at >5 years), whilst 17 (33%) improved significantly (one at <1 year, two at 1–2 years, eight at 2–5 years and six at >5 years). Those patients comprised five of 18 (27%) with epispadias and four of 34 (12%) with exstrophy. A history of previous surgery and gender had no significant effect on the outcome. Overall half the patients benefited from the procedure. CONCLUSIONS This series confirms that injection with Macroplastique is minimally invasive, durable in significantly many patients and has a reasonable success rate. A history of previous surgery and gender had no significant effect on the outcome. Patients with epispadias are more likely to benefit from an injection with Macroplastique than those with bladder exstrophy. A maximum of three injections is predictive with reasonable certainty of any benefit from the procedure.

Long-Term Outcome of the Pippi Salle Procedure for Intractable Urinary Incontinence in Patients with Severe Intrinsic Urethral Sphincter Deficiency

“…Table 4 summarizes the results of previous reports and our study regarding the success rates for IBA, and in particular the rates of achieving complete dryness after unsuccessful BNR for patients with N-ISD and A-ISD. [10][11][12][13][14][15][16][17] Although the success rates in previous reports averaged 31% (range: 7-70%), the rate in our study (100%) was substantially higher. To our best knowledge, there have been only 2 reports on IBA after the PSP, by Kitchens et al 16 and Misseri et al 17 (Table 4) Complete dryness was achieved in 2/11 (18%), including 1 patient who underwent the PSP.…”

The exstrophy-epispadias complex

“…After a mean follow-up of 12.5 years, continence or partial continence was achieved in 98% of the patients (most of these patients had also undergone bladder augmentation); however, only seven patients (18%) achieved continence with bladder-neck reconstruction alone, only 10 patients (21%) overall were able to void volitionally without intermittent catheterization (CIC), and 33 patients (69%) underwent bladder augmentation. Similar to the experience by Burki et al [25,26], they found that redo bladder-neck reconstruction alone could not produce continence in their patients; however, with bladder augmentation most achieved continence (91%).…”

“…Burki et al [25] reported results using polydimethylsiloxane injected at the bladder neck for treatment of incontinence in 52 patients. Continence was defined as complete dryness.…”

Outcome of continence procedures after failed endoscopic treatment with dextranomer-based implants (DEFLUX®)

“…Several authors mention that surgery at the bladder neck after injection(s) of Deflux or Macroplastique was not considered more difficult than in non-injected patients [6,8,9]; however, there is usually no mention of the technique used or of the results achieved. We have addressed these two points in the current study.…”