You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011825 EFFICACY OF DEXTRONOMER/HYALURONIC ACID BLADDER NECK INJECTION FOR PERSISTENT INCONTINENCE AFTER SLING IN CHILDREN WITH NEUROGENIC BLADDER Daniel DaJusta, Patricio Gargollo, and Warren Snodgrass Daniel DaJustaDaniel DaJusta Dallas, TX More articles by this author , Patricio GargolloPatricio Gargollo Dallas, TX More articles by this author , and Warren SnodgrassWarren Snodgrass Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.644AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our protocol for children with neurogenic bladder and persistent urinary incontinence from sphincteric incompetency after 360° fascial sling around the outlet has been 1–2 dextranomer/hyalurinic acid (Dx/HA) bladder neck (BN) injections before recommending surgical BN closure. Results are now presented. METHODS 26 patients with urinary incontinence due to persistent outlet incompetency after sling (n=17) or Ledbetter/Mitchell BN revision with sling (n=9) underwent 1 or 2 Dx/HA injections to the BN. Endoscopic approach was always initially antegrade through the appendicovesicostomy (n=13), or then retrograde per urethra when BN visualization was not possible antegrade (n=6), or both antegrade and retrograde when antegrade injection did not appear effective (n=7). Injection was performed at 12, 3, 6 and 9 o'clock until visual coaptation was achieved or material persistently leaked from prior injection sites. Data was recorded prospectively in a database. RESULTS Only 6 (26%) of the 23 children with follow-up achieved sustained continence, 5 with 1 treatment and 1 with 2 injections. 1st injection Of 23 patients with follow-up, 9 (39%) were initially dry, with recurrent leakage in 4 at a mean of 16 months (2 to 30) while 5 remained continent at mean follow-up of 27 months (6 to 52). The other 15 (61%) did not improve. Mean injected volume was 2.2 cc (1.5 to 3) for those with durable success versus 2cc (0.7 to 4) for failures (p=0.56). 2nd injection Of 12 patients with follow-up, 4 (33%) were initially dry, with recurrent leakage in 3 at mean of 12 months (8 to 19) while the other is dry at 39 months. Injection failed in the remaining 8 (67%). Five sling patients and 1 Ledbetter / Mitchell sling patients became dry (p=0.37). CONCLUSIONS Only 26% of patients had sustained continence after Dx/HA bladder neck injection. Approximately half those initially dry had recurrent leakage at a mean of 16 months after 1st injection. 2nd injection gave sustained continence to only 1 patient. While Dx/HA injection remains an option despite low success rates, we no longer recommend 2nd injections and inform patients with incontinence after slings that BN closure is the best treatment to achieve continence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e332 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel DaJusta Dallas, TX More articles by this author Patricio Gargollo Dallas, TX More articles by this author Warren Snodgrass Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...