Use of polydimethylsiloxane for endoscopic treatment of neurogenic urinary incontinence in children.
OBJECTIVE
We report on the injection of polydimethylsiloxane for endoscopic treatment of urinary incontinence in children with neurogenic bladder and determine the optimal criteria for patient selection.


METHODS
We have treated 17 boys and 16 girls since 1995. The etiology of incontinence was spina bifida in 24 cases. Previous surgery was performed in 18 patients, including bladder neck reconstruction in 15 and bladder augmentation in 9. Mean patient age at injection was 13 years (range 7 to 17). We administered 1, 2 and 3 injections in 21, 11 and 1 patients, respectively. Mean volume at each injection was 3.2 cc. Mean interval between injections was 6 months (range 3 to 15). In all cases injection was done transurethrally.


RESULTS
Followup ranged from 6 to 41 months (median 16). A total of 11 patients (33.3%) are dry (continence for greater than 4 hours and no urinary pad use during the day) and 8 (24.2%) are improved (continence for 2 to 3 hours and minimal pad use). Results are poor in 14 cases. Overall previous bladder neck surgery or preoperative detrusor hyperactivity did not influence results. Good results were mainly associated with female gender (47.4% of girls versus 10.5% of boys achieved cure).


CONCLUSIONS
Injection of polydimethylsiloxane at the bladder neck resulted in continence in 33% of neurogenic bladder cases. Better results occurred in girls and injection did not compromise other surgical procedures. Polydimethylsiloxane seems more suitable than bovine collagen due to potential problems with biological product use.
Guys
J M
JM
Fédération de Chirurgie Pédiatrique, Hôpital d'enfants de la Timone, Marseille, France.
Simeoni-Alias
J
J
Fakhro
A
A
Delarue
A
A
D000293:Adolescent; D002648:Child; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D012828:Silicones / Q000008:administration & dosage*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*
D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon