Polydimethylsiloxane in the Treatment of Sphincter Weakness Incontinence in Men with Spinal Cord Injury: Long-Term Follow-Up

Abstract

To assess the long-term effectiveness of polydimethylsiloxane (PDS, Macroplastique TM ) perisphincteric injections in treating male sphincter weakness incontinence (SWI) caused by spinal cord injury (SCI). Patients and methods: Fourteen male patients with SCI underwent PDS injection to the external urethral sphincter for SWI (mean age: 50.1 years; range: 32-79 years).A single surgeon at a specialist spinal injury unit managed all patients. Complete cure was defined as cessation of pad usage with no evidence of leakage on video cystometrogram (VCMG). Partial cure with improvement was defined as >50% reduction in the number of pads used with incontinence present on VCMG. Results: Twelve of the 14 patients had a mean (range) follow-up of 8.7 (6.8-10.5) years. One patient was lost to follow-up at 2 years and one other died at 19 months from an unrelated chest infection. Four patients required repeat injections. Cure was achieved in three patients (25%); two were completely dry at 7.5 years while one was partially dry at 8.7 years. The remaining nine patients required further interventions to achieve continence. Conclusion:The use of PDS can be contemplated as first-line treatment in SWI in SCI patients. The long-term effect can, however, be non-durable and repeat injections may be required.

Bulking for stress urinary incontinence in men: A systematic review

“…In fact, recruitment to the study was curtailed as the mean leakage, assessed by 24‐hour pad weight test, more than doubled during follow‐up compared to baseline. Similarly, poor outcomes were reported in a spinal cord injury population by Attar et al using Macroplastique. Both studies showed a moderate risk of bias.…”

“…The authors hypothesized that because of the older population group and iatrogenic neurovascular damage due to prostatectomy, the periurethral collagen could be less supportive . It should be noted, however, that Attar et al reported similarly high failure rates in a younger population in the absence of prostatic surgery.…”

“…The latter found no statistically significant difference within a subgroup analysis. Two studies included only neurological patients but outcomes ranged from very poor (Attar et al) to excellent (Renald et al)…”

“…Lee et al reported a fall in success rate from 43% to 32% between 1 and 6 months postinjection, however, 37% of their cohort was lost to follow‐up by the second time point, making meaningful analysis difficult. Attar et al described an initial dry rate of 33% at 6 weeks post the first injection with 17% dry at a follow‐up of 7.5 years with only 14% lost to follow‐up at this extended time frame. In contrast, Pannek et al reported a sharp fall‐off in response rate from 66% at 6 months to 33% at 1‐year.…”