title: Long-term efficacy of polydimethylsiloxane (Macroplastique) injection for Mitrofanoff leakage after continent urinary diversion surgery.
abstract: OBJECTIVE
  To assess the long-term efficacy of polydimethylsiloxane (Macroplastique) injection (MPI) in the treatment of Mitrofanoff leakage secondary to valve incompetence.
  
  
  METHODS
  Between 1995 and 2012, the records of 24 consecutive patients who underwent MPI for Mitrofanoff urinary leakage after continent cutaneous urinary diversion (CCUD) surgery were examined. All patients had a valve deemed of sufficient length (>2 cm) to attempt Macroplastique coaptation. Treatment outcomes were divided into three categories based on physician assessment: success (dry), partial success (>50% reduction in incontinence pads) and failure. Success rates were assessed according to the type of reservoir and conduit channel.
  
  
  RESULTS
  The mean (range) follow-up was 30 (6-96) months. One patient had initial difficulty catheterising, and subsequently required major revision surgery. In all, 12 patients (50%) failed the treatment and subsequently underwent operative revision to the channel. Three patients (12.5%) achieved complete success; one patient had an appendix channel through native bladder and the remaining two had Monti channels through colon. Nine patients (37.5%) had partial success; success rates were higher with appendix channels (four of six) and colonic reservoirs (six of seven) when compared with Monti channels (eight of 18, 44%) and ileal reservoirs (zero of two). Five of the nine patients with partial success eventually required further surgical revision for deteriorating continence at a mean (range) of 41 (14-96) months, whilst the other four have maintained sufficient continence with MPI alone.
  
  
  CONCLUSIONS
  Macroplastique bulking cured only 12.5% patients, but leakage was substantially improved in a further 37.5% allowing major surgery to be avoided or postponed in one half of the cohort. Appendix Mitrofanoffs do better than the Monti Mitrofanoff, with channels through colonic segments generally doing better than those through ileal bladders. MPI should be considered as a less invasive alternative to avoid or delay major reconstructive surgery.
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Antoine
authors.initials: A
authors.lastname: Kass-iliyya
authors.forename: Tina G
authors.initials: TG
authors.lastname: Rashid
authors.forename: Isabella
authors.initials: I
authors.lastname: Citron
authors.forename: Charlotte
authors.initials: C
authors.lastname: Foley
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.forename: Tamsin J
authors.initials: TJ
authors.lastname: Greenwell
authors.forename: P Julian R
authors.initials: PJ
authors.lastname: Shah
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Ockrim
mesh_terms: D000328:Adult; D000368:Aged; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon
keywords: Macroplastique®; Mitrofanoff; continent urinary; diversion; polydimethylsiloxane