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Results of Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence In Patients with Exstrophy Epispadias Complex

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Ilona Alova1, Pauline Clermidi1, Michele Bernuy2, Stephen Lortat-Jacob3 and Henri Lottmann4, (1)Paediatric Surgery, Necker Enfants Malades Hospital, Paris, France, (2)Reabilitation, Fondation Ellen Poidatz, Saint Fargeau Ponthierry, France, (3)Urologie Pediatrique, Hopital Necker Enfants Malades, Paris, France, (4)Urologie Pediatrique, H˘pital Necker Enfants Malades, Paris, France

Purpose: to evaluate prospectively the efficacy of  Dextranomer based implants  as a bulking agent for the endoscopic treatment of  urinary incontinence in patients with exstrophy epispadias complex.

Methods: Since October 1997, 38 children and adolescents have been enrolled in an ongoing study: Female epispadias 7, male epispadias 15 and bladder exstrophy 16. 23 had had a previous bladder neck continence procedure (BNR). Preoperative evaluation consisted in medical history, incontinence charts, urine culture, urinary tract ultrasound and videourodynamics. This evaluation was repeated at six months and one year after treatment and then on a yearly basis ,except for videourodynamics performed only when necessary for further management . Patients had one to three treatment sessions. Mean injected volume was 4,6 ml per session. At each evaluation, the patient was classified as cured (dryness interval of four hours ), significantly improved (minimal incontinence requiring no more than one pad per day; no further treatment required) and treatment failure when no significant improvement was observed. Follow-up ranged from 1  to 14 years (mean 8 years).

Results: There were four post treatment complications : perineal abcess(1), encrusted cystitis(1), peritoneal urinoma (1) and urinary retention(1).   Female epispadias: treatment failed in 2/2 before BNR and 3/5 after BNR, 2patients were improved. Male epispadias: before BNR,3/10 patients became dry and 7/10 had no improvement; after BNR: 7/7 patients became dry(6) or significantly improved(1). Bladder exstrophy: treatment failed in  5/5 before BNR and 3/11 after BNR; 5/11 became dry and 3/11 significantly improved

Conclusion: Endoscopic treatment has a low success rate (18%) as a primary continence procedure in the exstrophy epispadias complex except in selected male epispadias where continence can be achieved with endoscopic treatment alone. However it is associated with a significant cure and improvement rate (74%) after a previous unsuccessfull BNR particulalry in exstrophy and male epispadias patients. Female epipsadias seems to be the worst indication for endoscopic treatment.