The treatment of male stress urinary incontinence with polydimethylsiloxane in compliant bladders following spinal cord injury

Abstract

Study design: Retrospective analysis. Objectives: To evaluate the safety and efficacy of polydimethylsiloxane (PDS, Macroplastiquet) submucosal injections, in the treatment of male genuine stress urinary incontinence secondary to spinal cord injury (SCI). Setting: London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK. Patients and methods: A retrospective analysis identified 14 patients treated with PDS for stress urinary incontinence secondary to SCI between 1997 and 2001. A single surgeon at a specialist spinal injuries unit managed all patients. A total of 13 patients had suffered a traumatic SCI (T11:n ¼ 2; T12:n ¼ 5; L1:n ¼ 5; L2:n ¼ 1), while one developed stress incontinence after spinal surgery. The mean age was 41 years (range 26-69 years) and the mean duration of injury was 9.6 years (range 1.5-48 years). The preoperative investigations included video cystometrogram (VCMG) confirming the presence of urodynamically proven stress incontinence without evidence of urge incontinence. Complete cure was defined as a cessation of pad usage with no evidence of leakage on VCMG. Incomplete cure with improvement was defined as a 450% reduction in the number of pads used, with incontinence present on VCMG. Results: The follow-up ranged from 12 to 58 months (mean 34.7 months). Five patients (36%) reported complete success, confirmed by VCMG. Three patients (21%) reported improvement with 450% reduction in the use of pads. The procedure failed completely in six patients (43%). No immediate or late complications were noted with the procedure. Conclusions: The use of PDS is a safe and minimally invasive treatment for genuine stress urinary incontinence in males following SCI with a stable compliant bladder. We achieved complete cure in 36% of our patients with confirmation on VCMG. A further 21% reported greater than 50% reduction in usage of pads; however, on VCMG stress incontinence was demonstrated in these patients. We suggest that PDS can be used as the first line of treatment in this difficult group of patients with complex problems.

The use of urethral bulking injections in post‐prostatectomy stress urinary incontinence: A narrative review of the literature

“…Some argue that a single injection is sufficient to identify responders. 44 Supporting evidence can be found in several single-injection studies that report comparable success rates to their multi-injection counterparts ( Table 2). Interestingly a statistically significant correlation between repeated injections and worse long-term outcomes was also reported.…”

“…Accounts differ across studies. Some argue that a single injection is sufficient to identify responders . Supporting evidence can be found in several single‐injection studies that report comparable success rates to their multi‐injection counterparts (Table ).…”

“…Aside from PPI, BA use had also been reported in male neuropathic and pediatric populations . Furthermore, it had been proven that prior BA injections do not affect outcomes of subsequent surgical interventions should the need arise …”

“…Aside from PPI, BA use had also been reported in male neuropathic and pediatric populations. 42,44,48 Furthermore, it had been proven that prior BA injections do not affect outcomes of subsequent surgical interventions should the need arise. 49 Even though BA use had decreased over the last decade because of its lack of efficacy and reliability and advances in slings, a study reported urethral BA injections "remain the exclusive incontinence procedure for PPI performed by 49% of US urologists" as of 2010.…”

Long-term efficacy of AMS 800 artificial urinary sphincter in male patients with urodynamic stress incontinence due to spinal cord lesion

“…Recently, 36% continence rates were quoted with polydimethylsiloxane, at a mean follow-up of 20 months, in incontinent male spinal injury patients. 6 Scott et al 7 were first to report the use of silicone AUS for treatment of urinary incontinence in 1973. Generally complications like urethral atrophy, erosion and infection secondary to AUS implantation are reported to be more in patients with neurogenic bladder with USI.…”