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• W2001520756 abstract "No AccessJournal of UrologyAugmentation/Reconstruction1 Oct 2002The Effect of Endoscopic Injections of Dextranomer Based Implants on Continence and Bladder Capacity: A Prospective Study of 31 Patients H.B. Lottmann, M. Margaryan, M. Bernuy, M.-J. Rouffet, M.-O. Bau, A. El-Ghoneimi, Y. Aigrain, A. Stenberg, and G. Läckgren H.B. LottmannH.B. Lottmann More articles by this author , M. MargaryanM. Margaryan More articles by this author , M. BernuyM. Bernuy More articles by this author , M.-J. RouffetM.-J. Rouffet More articles by this author , M.-O. BauM.-O. Bau More articles by this author , A. El-GhoneimiA. El-Ghoneimi More articles by this author , Y. AigrainY. Aigrain More articles by this author , A. StenbergA. Stenberg More articles by this author , and G. LäckgrenG. Läckgren More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64431-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A prospective study was conducted to assess the efficacy of dextranomer based implants as a new bulking agent for endoscopic treatment of pediatric structural incontinence. Materials and Methods: A total of 33 children and adolescents 5 to 18 years old with severe incontinence due to sphincteric incompetence (exstrophy-epispadias in 13, neuropathic bladder in 16, bilateral ectopic ureters in 4) were enrolled in the study. All but 1 patient wore diapers. Preoperative evaluation consisted of medical history, pad test, urine culture, urinary tract ultrasound and videourodynamics. This evaluation was repeated 6 months and 1 year after treatment and then on a yearly basis. Of the patients 14 had 2 and 1 had 3 treatment sessions to achieve a definitive result. At each evaluation the patient was considered cured—dryness interval of 4 hours confirmed by pad test, significantly improved—minimal incontinence requiring no more than 1 pad a day with less than 10 gm. leakage during pad test; and no further treatment required, and treatment failure—no significant improvement. Videourodynamics were mainly useful to study the evolution of the bladder capacity, activity and compliance. Followup after the last injection ranged from 6 to 36 months (mean 18). Results: The mean injected volume was 3.9 ml. (range 1.6 to 12) and the procedure lasted a mean of 30 minutes (10 to 60). In the postoperative period 2 patients had temporary dysuria and 10 had a nonfebrile urinary tract infection. At 1 month 24 of the 33 patients (73%) were dry or improved. Two patients were subsequently excluded from study for noncompliance with followup. At 6 months 17 of 31 patients (55%), at 1 year 13 of 28 (46%), at 2 years 10 of 23 (43%) and at 3 years 10 of 20 (50%) were dry or improved. Similar success occurred in cases of neuropathic bladder (57%) and exstrophy-epispadias complex (46%). Success rate of re-treated patients was 35%. Of 13 patients with a normal initial bladder capacity 3 had a bladder decompensation requiring augmentation after 6 months. Also an increase of at least 50% in capacity was observed in 12 of 18 patients with an initial small bladder. No side effect related to the substance was observed. Conclusions: Endoscopic treatment of pediatric structural urinary incontinence with dextranomer implant, a nontoxic, nonimmunogenic, nonmigrant synthétic substance, was effective after 3 years in half of our patients. It may also be beneficial for patients with small bladder functional capacity. As the success rate decreased during the first year of followup, the result observed at 1 year seems to remain stable subsequently. References 1 : Assessment and current management of bladder outlet incontinence in children. In: Atlas of the Urologic Clinics of North America. Edited by . Philadelphia: W. B. Saunders Co.2001: 119. chapt. 9.1. Google Scholar 2 : Injectable bulking agents in the treatment of urinary incontinence. In: Pediatric Urology. Edited by . Philadelphia: W. B. Saunders Co.2001: 1008. chapt. 66. Google Scholar 3 : Long-term followup of children treated with dextranomer copolymer for vesicouretral reflux. J Urol2001; 166: 1887. Link, Google Scholar 4 : Polytetrafluoroethylene injection for urinary incontinence in children. J Urol1985; 133: 248. Link, Google Scholar 5 : The treatment of urinary incontinence in children using glutaraldehyde cross-linked collagen. J Urol1992; 148: 127. 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Google Scholar From the Pediatric Urology Department, Fondation Hopital Saint-Joseph, Paris, the Urotherapy Unit, Fondation Ellen Poidatz, St. Fargeau Ponthierry, the Pediatric Surgery Department, Hopital Robert Debré, Paris, France, and the Section of Urology, University Children’s Hospital, Uppsala, Sweden© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLloyd J, Spano S, Ross S, Wiener J and Routh J (2012) How Dry is Dry? A Review of Definitions of Continence in the Contemporary Exstrophy/Epispadias LiteratureJournal of Urology, VOL. 188, NO. 5, (1900-1904), Online publication date: 1-Nov-2012.Elmi A, Kajbafzadeh A, Tourchi A, Talab S and Esfahani S (2011) Safety, Efficacy and Health Related Quality of Life of Autologous Myoblast Transplantation for Treatment of Urinary Incontinence in Children With Bladder Exstrophy-Epispadias ComplexJournal of Urology, VOL. 186, NO. 5, (2021-2026), Online publication date: 1-Nov-2011.Haddad M, Besson R, Aubert D, Ravasse P, Lemelle J, El Ghoneimi A, Moscovici J, Hameury F, Baumstarck-Barrau K, Hery G and Guys J (2010) Sacral Neuromodulation in Children With Urinary and Fecal Incontinence: A Multicenter, Open Label, Randomized, Crossover StudyJournal of Urology, VOL. 184, NO. 2, (696-701), Online publication date: 1-Aug-2010.Kajbafzadeh A, Elmi A, Payabvash S, Salmasi A, Saeedi P, Mohamadkhani A, Sadeghi Z and Nikfarjam L (2008) Transurethral Autologous Myoblast Injection for Treatment of Urinary Incontinence in Children With Classic Bladder ExstrophyJournal of Urology, VOL. 180, NO. 3, (1098-1105), Online publication date: 1-Sep-2008.Dean G, Kirsch A, Packer M, Scherz H and Zaontz M (2007) Antegrade and Retrograde Endoscopic Dextranomer/Hyaluronic Acid Bladder Neck Bulking for Pediatric IncontinenceJournal of Urology, VOL. 178, NO. 2, (652-655), Online publication date: 1-Aug-2007.Kitchens D, Minevich E, DeFoor W, Reddy P, Wacksman J, Koyle M and Sheldon C (2018) Incontinence Following Bladder Neck Reconstruction—Is There a Role for Endoscopic Management?Journal of Urology, VOL. 177, NO. 1, (302-306), Online publication date: 1-Jan-2007.Lottmann H, Margaryan M, Lortat-Jacob S, Bernuy M and Läckgren G (2018) Long-Term Effects of Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence: An Update of a Prospective Study of 61 PatientsJournal of Urology, VOL. 176, NO. 4S, (1762-1766), Online publication date: 1-Oct-2006.Lottmann H, Margaryan M, Bernuy M, Grosz A, Aigrain Y, Lortat-Jacob S and Läckgren G (2018) Long-Term Effects of Dextranomer Endoscopic Injections for Treatment of Urinary Incontinence: An Update of a Prospective Study of 31 PatientsJournal of Urology, VOL. 175, NO. 4, (1485-1489), Online publication date: 1-Apr-2006.Guys J, Breaud J, Hery G, Camerlo A, Le Hors H and De Lagausie P (2018) Endoscopic Injection With Polydimethylsiloxane for the Treatment of Pediatric Urinary Incontinence in the Neurogenic Bladder: Long-Term ResultsJournal of Urology, VOL. 175, NO. 3, (1106-1110), Online publication date: 1-Mar-2006.BEDİR S, KİLCİLER M, ÖZGÖK Y, DEVECİ G and ERDURAN D (2018) LONG-TERM COMPLICATION DUE TO DEXTRANOMER BASED IMPLANT: GRANULOMA CAUSING URINARY OBSTRUCTIONJournal of Urology, VOL. 172, NO. 1, (247-248), Online publication date: 1-Jul-2004.ELDER J (2018) REVIEW OF PANEL DISCUSSIONSJournal of Urology, VOL. 171, NO. 6 Part 2, (2672-2679), Online publication date: 1-Jun-2004. Volume 168Issue 4 Part 2October 2002Page: 1863-1867 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsbladder exstrophyepispadias, endoscopy, dextransurinary incontinenceMetricsAuthor Information H.B. Lottmann More articles by this author M. Margaryan More articles by this author M. Bernuy More articles by this author M.-J. Rouffet More articles by this author M.-O. Bau More articles by this author A. El-Ghoneimi More articles by this author Y. Aigrain More articles by this author A. Stenberg More articles by this author G. Läckgren More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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