Pakkasjarvi N, et al. - Here, the researchers assessed whether technical success [defined as an intraoperative increase in abdominal leak point pressure (ALPP)] predicted the outcome of the treatment of sphincter insufficiency with urethral bulking agent. After dextranomer/hyaluronic acid (Dx/HA) injection, intraoperative increased ALPP did not predict a good long-term outcome. Only a fifth of the patients had a good result with 1 or more Dx/HA injections at the end. A change was possible in bladder behavior after treatment.

Methods

• All children treated first time with dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux) for urethral sphincter insufficiency and who intraoperatively had ALPPs measured during 2004–2014 were reviewed.
• The researchers assessed patient characteristics, change in urinary continence and the duration of the possible response in neurogenic and non-neurogenic cases.

Results

• At initial treatment, the median age of the patients was 7.8 years (range 4.1–14.5), and median volume of Dx/HA instilled was 3.5 mL (IQR 2–5).
• The researchers found neurogenic disease in 12 patients and non-neurogenic disease in 15 patients.
• Before and after the injections, median ALPPs were 19 cmH2O (IQR 14–28) and 70 cmH₂O (IQR 48–80), p < 0.001.
• They noted similar increases in ALPPs in both patient groups (p=0.661).
• Seventeen patients with any response and 10 patients with no response (p=0.267) showed increases in ALPPs.
• The median duration of the response was only 0.8 years (IQR 0.09-2.0) in patients with any response.
• Fifteen patients received 1 to 3 repeat injections and 8 patients went through sling or bladder neck operation during a median follow-up of 4.9 years (range 1.7-11.8).
• The preoperative ALPPs had returned to the original levels during repeat injections.
• Presently, 20% were revealed to be continent or almost continent with one or more Dx/HA injections.
• Compliance or volume deteriorated slightly in follow-up among half of the patients with neurogenic bladder.
• Out of 15 patients who reached puberty, 5 become continent spontaneously after failed bladder neck injection.