title: Outcome of continence procedures after failed endoscopic treatment with dextranomer-based implants (DEFLUX®).
abstract: OBJECTIVE
  To evaluate outcome of further continence procedures after failure of endoscopic injections of dextranomer-based bulking agent.
  
  
  METHODS
  From 1997, 89 children (3-18 years) and one young adult were treated for incontinence with 145 endoscopic injections of dextranomer. On evaluation, each patient was classified as: dry, significantly improved, or treatment failure. Eighty-five patients had at least 12 months of follow up. Out of 34 (40%) treatment failures, 24 patients had a subsequent bladder neck procedure: artificial urinary sphincter (7), bladder neck plasty (9), bladder neck closure (1), fascial sling (3). Six patients had further endoscopic treatment (including 2 after bladder neck plasty).
  
  
  RESULTS
  At surgery, Deflux(®) paste was easily identified with minimal surrounding tissue inflammatory reaction. Artificial urinary sphincter: all 7 dry; bladder neck plasty: 7 dry, 1 improved and 1 still incontinent; 1 bladder neck closure patient dry; fascial sling: 1 significantly improved and 2 dry. Repeated endoscopic treatment: 1 dry, 1 improved and 4 failed. Eleven of the 21 (52%) patients who are either dry or improved have voiding abilities.
  
  
  CONCLUSIONS
  Endoscopic injections with dextranomer do not adversely affect the outcome of further surgical procedures. Repeated injections after a previous endoscopic treatment failure have a low success rate.
authors.affiliation: Pediatric Surgery Department, (Pr Y. Révillon) Hop Necker Enfants-Malades, 149 Rue de Sèvres, 75015 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Alova
authors.forename: M
authors.initials: M
authors.lastname: Margaryan
authors.forename: V
authors.initials: V
authors.lastname: Verkarre
authors.forename: M
authors.initials: M
authors.lastname: Bernuy
authors.forename: S
authors.initials: S
authors.lastname: Lortat Jacob
authors.forename: H B
authors.initials: HB
authors.lastname: Lottmann
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle; D001746:Bladder Exstrophy / Q000150:complications / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003558:Cystoscopy / Q000379:methods*; D003911:Dextrans / Q000009:adverse effects* / Q000494:pharmacology; D004842:Epispadias / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects* / Q000494:pharmacology; D007150:Immunohistochemistry; D015552:Injections, Intralesional; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D018570:Risk Assessment; D017211:Treatment Failure; D014549:Urinary Incontinence / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis; D055815:Young Adult
chemical_list: D003911:Dextrans; C094535:deflux; C013471:dextranomer; D006820:Hyaluronic Acid