The long term results of bulking agent injection as a treatment of remaining incontinence in neurogenic bladder dysfuncTION

Abstract

Purpose To evaluate the effectiveness of bulking agent injection (BAI) in the bladder neck as supplementary treatment of persistent low-pressure incontinence after primary fascial sling procedure. Material and methods Between 1992 and 2005 eighty nine patients with neurogenic lower urinary tract dysfunction underwent fascial sling procedure. Because of unsatisfactory results in 27 children endoscopic injection of a bulking agent was applied. In all patients urodynamic study after the sling procedure showed low-pressure leakage. Endoscopic approach (retrograde, antegrade or both), way of postoperative catheterization and number of sessions were retrospectively analysed. Results of BAI were graded by the patient and the urologist. Results At median (range) follow-up of 8 (2,5-14) years only two were continent after one injection (7%). Thirteen (48%) were given a second and a third bulking agent and four even a fourth one, but these did not result in dryness. The first BAI was given at a median of 13, the second after 20, the third after 31,5 months after the sling operation. Finally 16 patients (59%) had bladder neck surgery. In three patients (11%) ileocystoplasty was done because of decrease in BC and poor compliance. The endoscopic approach and technique of postoperative catheterization did not affect success rate. Conclusions There is no place for repeated BAI in patients with neurogenic sphincter dysfunction after failure of primary sling procedure.