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


OBJECTIVE
To evaluate the safety and efficacy of polydimethylsiloxane (PDS, Macroplastique) submucosal injections, in the treatment of male genuine stress urinary incontinence secondary to spinal cord injury (SCI).


METHODS
London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK.


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=2; T12:n=5; L1:n=5; L2:n=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 >50% 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 >50% 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.
Hamid
R
R
Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK.
Arya
M
M
Khastgir
J
J
Patel
H R H
HR
Shah
P J R
PJ
D000328:Adult; D000368:Aged; D004129:Dimethylpolysiloxanes / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D012828:Silicones / Q000009:adverse effects / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000150:complications*; D013526:Surgical Mesh; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000188:drug therapy* / Q000209:etiology; D014743:Videotape Recording / Q000379:methods
D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon