MP11-06: Endoscopic Injection Of The Bladder Neck Using Dextranomer Hyaluronate (Dx/Ha) In The Pediatric Patient: Results Of A Single Center Analysis With Long Term Follow Up

Jennifer M. Lovin*, Nelson Kuete, Shuvro De, Andrew J. Kirsch, Atlanta, GA

Introduction: Urinary incontinence (UI) in the pediatric neurogenic bladder may result from sphincteric or bladder neck incompetence. Surgical treatment options include bladder neck reconstruction, bladder neck sling and artificial urinary sphincter placement. Unfortunately, success is highly variable and interventions are associated with morbidity. A minimally invasive approach using endoscopic bladder neck injection (EI) is desirable due reduced morbidity and shorter convalescent times. Factors associated with success include female gender, non-ambulatory status, and prior bladder neck reconstruction; however, results in the literature are conflicting. Therefore, we aim to determine the effect of patient characteristics and surgical factors on success of EI.

Methods: We retrospectively reviewed 105 children who underwent EI with Dx/HA from 2003-2020 at our institution. Ninety-seven patients met inclusion criteria, with 133 injections performed. Patient characteristics and surgical factors were evaluated. Success was defined as dry or improved UI following EI without need for further treatment.

Results: Overall, 50.5% of children had successful treatment with a median follow up of 69 months. Univariate analysis revealed non-ambulatory status was significantly associated with treatment success (65% vs 42%, p 0.037). While female patients demonstrated superior success compared to their male counterparts, this variable did not reach statistical significance (57.6% vs 43.6%, p 0.225). Urodynamic parameters (capacity, compliance, abdominal leak point pressure), and surgical factors (injection technique/volume) did not affect success. Multivariate analysis revealed that prior bladder neck sling (OR 0.3, 95% CI 0.1-0.9) was associated with failure, with a success rate of only 30.5%. Non-ambulatory status trended towards treatment success (OR 2.6, 95% CI 0.98-7.1).

Conclusions: EI in patients with bladder outlet incompetence demonstrates increased success rates in non-ambulatory patients. Previous bladder neck sling is associated with higher treatment failure. Other factors (surgical technique, injection volume) did not affect treatment success. Despite a relatively low success rate (50%), EI represents a reasonable low morbidity alternative to other surgical therapy for management of pediatric UI. Prospective studies are necessary to resolve disparate outcomes reported in the literature.

Source of Funding: None