The following is a summary of “Outcomes after dextranomer/hyaluronic acid bladder neck injection in patients with urethral incontinence following bladder neck repair,” published in the December 2023 issue of Urology by Stout, et al.
Incontinence may persist after bladder neck (BN) surgery for many individuals. Dextranomer/hyaluronic acid (Dx/HA) is routinely used to treat endoscopic vesicoureteral reflux in children, but research has examined its use for BN surgical incontinence. For a study, researchers sought to examine Dx/HA bladder neck injection results in individuals with persisting outlet incompetency after BN Repair. They retrospectively analyzed patients at a single pediatric tertiary care institution who had bladder neck surgery and persistent incontinence and received endoscopic bladder neck Dx/HA injections from 2013 to 2018 and had follow-up. The key outcomes of reported incontinence were “wet” (leakage comparable to before injection), “improved” (wet but leakage improved), and “dry” (no leakage). After the Dx/HA injection, They needed bladder neck closure or another operation.
At initial follow-up (median 2.3 months post-op), 7/19 were wet, 6/19 better, and 6/19 dry. Only three patients (16%) remained dry at the final follow-up (median 34.7 months). Single Dx/HA injection surgery left just one patient “dry,” but approximately 2/3rds (12) were “improved” incontinence. Seven individuals underwent further surgery or injections. Two of five patients with numerous Dx/HA injections after initial surgery were dry by final examination. Their patients (21% of the group) needed bladder neck closure (BNC).
Their investigation found that one patient with a single Dx/HA injection remained dry after further follow-up. Several studies followed up for over a year after a bladder neck Dx/HA injection; dryness rates after a single surgery ranged from 20% to 40% over 1.5 to 7 years. Their study has limitations. In the retrospective analysis, a single surgeon reviewed the medical record to establish surgical procedures and continence results. The patient population is modest but similar to other research. Results were subjective since they were based on patient accounts. A single Dx/HA BN injection is unlikely to provide long-term dryness for patients with failed BN repair, although one-third may ameliorate incontinence.
Source: sciencedirect.com/science/article/abs/pii/S1477513123002929