Cystoscopic Injections of Dextranomer Hyaluronic Acid Into Proximal Urethra for Urethral Incompetence: Efficacy and Adverse Outcomes

• Published in: Urology (Ridgewood, N.J.) N.J.), 2010-06, Vol.75 (6), p.1310-1314
• Main Authors: Lightner, Deborah J, Fox, Janelle, Klingele, Christopher
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cohort Studies; Cystoscopy - methods; Dextrans - adverse effects; Dextrans - therapeutic use; Female; Follow-Up Studies; Humans; Hyaluronic Acid - adverse effects; Hyaluronic Acid - therapeutic use; Injections, Intralesional; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Quality of Life; Retrospective Studies; Risk Assessment; Safety Management; Severity of Illness Index; Treatment Outcome; Urethra - drug effects; Urethra - physiopathology; Urodynamics; Urology; Vesico-Ureteral Reflux - diagnosis; Vesico-Ureteral Reflux - drug therapy
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2009.12.061

Objectives To determine whether dextranomer/hyaluronic acid would be more efficacious or would produce fewer complications when using the material in a standard proximal-urethra cystoscopically-directed injection technique. Injectable periurethral bulking agents are an alternative to stress incontinence surgery. Dextranomer, a highly hydrophilic dextran polymer, solubilized in a base of nonanimal stabilized hyaluronic acid, has been approved as an injectable agent for the treatment of childhood vesicoureteric reflux (Deflux, Q-Med AB, Uppsala, Sweden), and in Europe for women with stress urinary incontinence (SUI) (Zuidex, Q-Med AB, Uppsala, Sweden). A previous multicenter trial demonstrated nonequivalence compared with bovine glutaraldehyde cross-linked collagen with a high complication rate. We sought to determine whether the failure of the treatment lay in the material itself or the use of a blind, midurethral injection technique. Methods A retrospective case series of 56 patients undergoing cystoscopically guided bladder neck injections of dextranomer/hyaluronic acid with follow-up in 42, included 35 women with intrinsic sphincter deficiency (ISD), 4 men with postprostatectomy incontinence, 2 men with sphincteric denervation secondary to spinal cord injury, and 1 woman with sphincteric failure after a neobladder. Outcome assessment used gender-appropriate International Consultation on Incontinence Questionnaire, clinical records, and/or urodynamic assessment. Results Of 35 women with ISD, 4 developed pseudoabscess formation with outlet obstruction requiring multiple operative interventions. Patient-defined treatment failure occurred in all 4 carefully selected postprostatectomy incontinent men, and in 23 of 35 females with ISD. Conclusions Complications with cystoscopically injected dextranomer hyaluronic acid at the bladder neck occurred at a high rate, and using a validated questionnaire, the efficacy of dextranomer hyaluronic acid applied in this manner for ISD was poor.