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Analysis of Outcomes Using Dextranomer Hyaluronic ACID Copolymer (DHA) Injections for the Treatment of MACE or Mitrofanoff Incontinene As Well As Bladder Neck Incontinence Following Continent Urological Reconstruction Procedures

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Kevin K. Birusingh, MD1, Tyler Thress, MS1, J. Patrick Murphy2 and John M. Gatti, MD2, (1)Urology, Kansas University Medical Center, Kansas City, KS, (2)Urology, Children's Mercy Hospital, Kansas City, MO

Purpose: To analyze the outcomes for those patients who underwent continent urological reconstruction procedures and then subsequently required  dextranomer hyaluronic acid copolymer (DHA) injection for mace or mitrofanoff stomal incontinence or urethral incontinence.

Methods: We performed a retrospective chart review of children under the age 18 who underwent a continent Urological reconstruction procedure done at our institution from 1990−2010. The patient’s diagnosis, details of procedure, number of months from initial procedure to repeat procedure, age at diagnosis, age at procedure, repeat procedures, age at repeat procedures, complications, outcomes (as defined by continence status), and clinic follow−up findings were collected for analysis. Emphasis was placed on those patients in which DHA injection was used for stomal leakage or urethral incontinence. Incontinence was defined as any leakage of stool or urine. 

Results: Fifty−eight patients underwent a total of 126 reconstruction procedures. Ages ranged from 1.25 to 18 years (mean 9.6). Reconstruction procedures performed included Malone antegrade catheterizable enema (MACE) (37), mitrofanoff (43), bladder augmentation (16), bladder sling (10), bilateral ureteral reimplants (7), unilateral ureteral reimplant (6), bladder neck closure (4), and bladder neck reconstruction (3). DHA injections were performed in thirteen patients secondary to leakage in MACE (10), mitrofanoff (13), and urethra (6). Time from initial operation to first DHA injection ranged from 1 −19 months (mean 7.4) Five patients (38%) required more than one injection. Continence was achieved in 8 (80%) of MACEs and 8 (62%) of mitrofanoffs undergoing DHA injections. Average number of injections needed to achieve continence was 2.3. Of the patients who had a bladder sling performed as part of their initial procedure, 5 (50%) required a deflux injection due to urethral incontinence with continence achieved in 3 (60%).

Conclusion: The use of DHA injection is a reasonable alternative to open reoperation in those patients experiencing stomal or urethral leakage following a continent urological reconstruction procedure given it is well tolerated, has minimal morbidity, and can be done in the outpatient setting.