Bladder Neck Injection of a Polydimethylsiloxane-Bulking Agent Under Pneumovesicum for Treatment of Children with Urinary Incontinence: Report of 3 Cases

Abstract

Introduction: To present the surgical technique and initial outcomes of bladder neck injection (BNI) of bulking agent under CO2-induced pneumovesicum to better visualize the bladder neck.

Subjects and Methods: Three children (one 12 year old and two 14 year olds) who underwent polydimethylsiloxane BNI under pneumovesicum for treatment of bladder neck incompetence were retrospectively reviewed. Patient diagnoses included an imperforate anus, joint hypermobility syndrome, and an ectopic ureter, respectively. BNI was performed with an antegrade approach under 10 mm Hg CO2 pneumovesicum after insertion of a 5-mm diameter trocar in the bladder dome. A single injection was given in all cases.

Results: BNI was successfully completed in all patients. Bleeding that developed during bladder access or injection did not interrupt accurate positioning of the needle or confirmation of mucosal coaptation in the bladder neck. At 6 months postoperatively, all patients reported social continence, defined as minimal incontinence requiring no more than one pad daily. No intraoperative morbidity or postoperative deterioration of the upper urinary tract due to technique was observed.

Conclusions: Antegrade BNI under pneumovesicum affords better visualization of the bladder neck, resulting in more accurate needle placement and better mucosal coaptation confirmation. Studies of larger patient samples are necessary to better study the efficacy of BNI with the patient under pneumovesicum.