Long-term efficacy of polydimethylsiloxane (Macroplastique) injection for Mitrofanoff leakage after continent urinary diversion surgery

Bulking agent treatment of incontinent catheterizable channels in pediatric patients and young adults

BACKGROUND

Catheterizable continent channels (CCC) provide means for urinary continence when urethral catheterization is not feasible. However, some patients present with stomal incontinence warranting further interventions. The purpose of this study is to evaluate the effectiveness of endoscopic injection (EI) of bulking agent (Deflux©) as a minimally invasive treatment for CCC incontinence and to explore patient-specific variables influencing outcomes in a pediatric cohort.

METHODS

Hospital's pediatric urology procedure registry was retrospectively reviewed to identify all patients with a CCC and at least one EI of bulking agent for the leakage of the stoma at our institution between 2001 and 2021. The postoperative outcomes were assessed three months after the procedure and annually thereafter.

RESULTS

A total of 21 children and young adults were included with CCC indications including neurogenic bladder (n = 13), bladder or cloacal exstrophy (n = 5) and other conditions (n = 3). The most common channel type was appendicovesicostomy (n = 7) followed by Monti tube (n = 5), spiral Monti (n = 3), ureter (n = 3), and other types (n = 3). The median age at first EI was 9.7 years (IQR 8.2-15.1) with a median follow-up time of 4.0 years (IQR 1.2-6.7). At follow-up, 11 patients (52 %) achieved continence. Surgical correction was ultimately required in nine patients (43 %) due to incontinence and in three patients for other reasons. No patient (0 %) experienced long term benefit from >1 injections.

CONCLUSION

Endoscopic injections offer a minimally invasive option and can be considered a first-line approach for treating CCC incontinence. However, surgical correction remains necessary for some patients. In our material, re-injections were ineffective.

The Extended Utilization of Bulking Agents in Pediatric Urology

PURPOSE OF REVIEW

Traditional surgical management for urinary incontinence and vesicoureteral reflux often requires complex reconstructive surgery and extended hospitalizations. Since the introduction of endoscopic bulking agents in 1973, there has been increasing interest in the use of endoscopic injection (EI) and bulking for the treatment of a variety of pediatric urologic disorders. The purpose of this review is to summarize the most recent literature addressing the use of bulking agents in pediatric urology.

RECENT FINDINGS

The most recent literature has focused primarily on the use of EI of bulking agents at the bladder neck for the treatment of urinary incontinence. Other uses of EI of bulking agents has focused on the treatment of vesicoureteral reflux (VUR) in patients with anatomic abnormalities or treatment of incontinence catheterizable channels. The development of advanced techniques for endoscopic injection along with safe, stable bulking agents has allowed for the treatment of a variety of urologic conditions. This minimally invasive procedure offers an additional tool for the pediatric urologist's armamentarium in the treatment of urinary incontinence and VUR.

Managing intractable incontinence from a Yang-Monti channel in a case of enterocystoplasty with bladder neck closure - Challenges and a modified surgical technique

Incontinence in the Mitrofanoff principle varies between 2% and 40% and is a challenging problem to treat. Incontinence is even more when a Yang-Monti channel is used with simultaneous enterocystoplasty, probably due to ineffective submucosal tunneling owing to the inferior quality of bowel mucosa. Here, we report the management options of such problems along with a novel surgical technique.