Antegrade and retrograde endoscopic dextranomer/hyaluronic Acid bladder neck bulking for pediatric incontinence.
OBJECTIVE
Endoscopic bladder neck bulking techniques offer the potential for a relatively noninvasive cure for a difficult clinical problem. We review our experience using antegrade and retrograde approaches.


METHODS
A total of 34 children (18 boys and 16 girls, mean age 11.7 years) have been treated since March 2003. Of the patients 28 (82%) had neurogenic bladder and 6 had nonneurogenic sphincteric incontinence. Urodynamics confirmed low detrusor leak point pressures and adequate bladder capacity. Patients were treated with either a retrograde or an antegrade approach. In 82% of patients an antegrade approach was used and a posttreatment suprapubic tube was placed.


RESULTS
Mean followup was 11.7 months (range 3 to 31). Patients averaged 1.47 injections (range 1 to 5). Detailed followup of 19 patients revealed significant improvement in continence in 78% (mean 1.6 injections), with an average followup of approximately 1 year.


CONCLUSIONS
Our 31 months of experience with antegrade/retrograde bladder neck bulking demonstrates that it is a viable therapy for this group of children. While some patients have experienced prolonged success, re-treatment can be beneficial. The antegrade approach offers several advantages, including intraoperative leak point pressures, improved visualization and placement of a suprapubic tube to limit post-procedural remodeling.
Dean
Gregory E
GE
Temple University Children's Medical Center, Philadelphia, Pennsylvania, USA.
Kirsch
Andrew J
AJ
Packer
Michael G
MG
Scherz
Hal C
HC
Zaontz
Mark R
MR
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid; D007267:Injections; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D019736:Prostheses and Implants; D012008:Recurrence; D012086:Reoperation; D017211:Treatment Failure; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000601:surgery*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid