title: Dextranomer/hyaluronic acid bladder neck injection for persistent outlet incompetency after sling procedures in children with neurogenic urinary incontinence.
abstract: OBJECTIVE
  We report outcomes after dextranomer/hyaluronic acid (Dx/HA) bladder neck injection for persistent outlet incompetency despite prior sling or Leadbetter/Mitchell bladder neck revision plus sling (LMS) in children with neurogenic urinary incontinence.
  
  
  METHODS
  Consecutive patients with outlet incompetency after sling (n = 17) or LMS (n = 9) underwent a maximum of 2 Dx/HA injections. Antegrade and/or retrograde endoscopy was used to access the bladder outlet, and injection done in quadrants to achieve visual mucosal coaptation. Outcomes were described as either "dry", not requiring pads, or "wet".
  
  
  RESULTS
  There were 24 children with follow-up after injection, of which 9 (38%) were initially dry and 15 (62%) remained wet. Of the 9 dry patients, 4 had recurrent incontinence at a mean of 16 months while 5 remained dry at a mean of 27 months. Second injections were done in a total of 14 children, with 1 dry at 39 months. Of all 24 children, up to 2 injections resulted in 6 (25%) dry patients, while the remainder was wet at last follow-up. Gender, initial outlet surgery, pre-injection pad use, injection technique, and volume injected did not predict outcomes.
  
  
  CONCLUSIONS
  Dx/HA bladder neck injection resulted in dryness in 25% of patients in this series after failed sling or LMS. Second injections after either initial failure or success achieved dryness in only 7%, and are no longer recommended.
authors.affiliation: Pediatric Urology Section, The University of Texas Southwestern Medical Center and, Children's Medical Center, Dallas, TX, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: DaJusta
authors.forename: Patricio
authors.initials: P
authors.lastname: Gargollo
authors.forename: Warren
authors.initials: W
authors.lastname: Snodgrass
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008297:Male; D053825:Suburethral Slings; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid