To assess the long-term efficacy of polydimethylsiloxane (Macroplastique® injection (MPI) in the treatment of Mitrofanoff leakage secondary to valve incompetence.
PATIENTS AND METHODS: Between 1995 and 2012, the records of 24 consecutive patients who underwent MPI for Mitrofanoff urinary leakage after continent cutaneous urinary diversion (CCUD) surgery were examined. All patients had a valve deemed of sufficient length (>2cm) to attempt Macroplastique® coaptation. Treatment outcomes were divided into three categories based on physician assessment: success (dry), partial success (>50% reduction in incontinence pads) and failure. Success rates were assessed according to the type of reservoir and conduit channel.
RESULTS: Mean follow-up was 30 months (range 6-96). 1 patient had initial difficulty catheterising, and subsequently required major revision surgery. 12 patients (50%) failed the treatment and subsequently underwent operative revision to the channel. 3 patients (12.5%) achieved complete success; 1 patient had an appendix channel through native bladder and the remaining 2 had Monti channels through colon. 9 patients (37.5%) had partial success; success rates were higher with appendix channels (4/6) (67%) and colonic reservoirs (6/7) (86%) when compared with Monti channels (8/18) (44%) and ileal reservoirs (0/2) (0%). 5/9 patients with partial success eventually required further surgical revision for deteriorating continence at a mean of 41 months (range 14-96) whilst the other 4 have maintained sufficient continence with MPI alone.
CONCLUSION: Macroplastique® bulking cured only 12.5% patients, but leakage was substantially improved in a further 37.5% allowing major surgery to be avoided or postponed in one half of the cohort. Appendix Mitrofanoffs do better than the Monti Mitrofanoff, with channels through colonic segments generally doing better than those through ileal bladders. MPI should be considered as a less invasive alternative to avoid or delay major reconstructive surgery.
Written by:
Kass-Ilya A, Rashid T, Citron I, Foley C, Hamid R, Greenwell T, Shah P, Ockrim J. Are you the author?
University College London Hospital, 235 Euston Road, London, NW1 2BU.
Reference: BJU Int. 2014 May 26. Epub ahead of print.
doi: 10.1111/bju.12817
PubMed Abstract
PMID: 24862487
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