STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: LONG TERM EFFECTS OF ENDOSCOPIC INJECTION WITH DEXTRANOMER/HYLAURONIC ACID COPOLYMER

INTRODUCTION AND OBJECTIVES: After radical prostatectomy due to prostate cancer a remarcably number of patients suffer of stress urinary incontinence (SIU). Dextranomer/hyaluronic acid copolymer (Deflux) is a substance which is easy to applicate, with a good biocompatibility and no tendency to migrate. In a retrospective study 21 patients in our department were injected for mild to moderarte stress incontinence after radical prostatectomy. Urethral injection of bulking agents as a minimal invasive treatment option for SUI was controlled for its efficacy and time of duration. METHODS: Between October 2003 and September 2007 21 male patients with mild to moderate SUI postoperative after radical prostatectomy were treated with endoscopic injection of Deflux. Injection site was in the anastomotic area. Prospectively all patients were interviewed by telephone. The endpoint of the study was the presence of incontinence and the number of pads per day respectively. Incontinence was defined as “the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing” according the definition of the International Continence Society (ICS) 2002. RESULTS: Operating time was 14 min (5 31min). Before injection a suprapubic catheter was inserted. Mean injected volume was 3.2 ml (2,5 4.5 ml). Mean hospital stay was 1,1 days (1 3 days). One patient had a hematuria from the suprapubic catheter which was treated conservatively. No other complications were reported. After a median follow-up of 30.7 months (8 55 months) all patients were interviewed by telephone. Before therapy all 21 patients had mean 3,3 (1-10) Pads/ day, In the long term follow up two patients of the 21 patients (9,5%) didn`t need any pads and were defined as continent. 19 patients (90,5%) showed no improvement post injection. In these patients the mean number of pads before and postoperatively didn`t change significantly (p > 0, 3). Meanwhile in 7 of these patients artifical devices were implanted (5 pts artificial sphincter, suburethral slings in 2 pts). CONCLUSIONS: The injection of Dextranomer/hyaluronic acid copolymer (Deflux) for SUI in patients after radical prostatectomy is a minimal invasive treatment option with a low complication rate. In the long term follow up the success rate of this technique was found to be 9,5%. The costs for the amount of used substance were dependent to the injected volume high. Only in selected cases endoscopic injection can be advised as treatment option.