Transurethral injection of bulking agents for stress urinary incontinence following orthotopic neobladder reconstruction in women

Abstract

Purpose: The clinical efficacy of transurethral bulking agents for the treatment of new onset urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women was evaluated.

Materials and methods: Between 1990 and 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Of the 101 patients 12 (12%) underwent treatment for new onset urinary incontinence following exenterative surgery with transurethral injection of bulking agents, including collagen in 11 and nonabsorbable pyrolytic carbon coated beads in 1.

Results: A total of 25 injections were administered to 12 female patients with a mean age of 75.4 years following orthotopic neobladder reconstruction. Mean followup was 22.5 months (range 2 to 51). Two of the 12 patients (16.7%) reported complete continence and were considered cured, although subjective complaints of urinary frequency persisted. Four patients (33%) had decreased objective average daily pad use (6.75 to 2.25) and 6 (50%) showed no subjective or objective improvement in symptomatology.

Conclusions: Although injection of urethral bulking agents is a minimally invasive treatment for stress urinary incontinence following orthotopic neobladder reconstruction, long-term results in patients with severe disease show a less than optimal durable response.