The treatment of male stress urinary incontinence with polydimethylsiloxane in compliant bladders following spinal cord injury

Study design: Retrospective analysis. Objectives: To evaluate the safety and efficacy of polydimethylsiloxane (PDS, Macroplastique(TM)) submucosal injections, in the treatment of male genuine stress urinary incontinence secondary to spinal cord injury (SCI). Setting: London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK. Patients and methods: A retrospective analysis identified 14 patients treated with PDS for stress urinary incontinence secondary to SCI between 1997 and 2001. A single surgeon at a specialist spinal injuries unit managed all patients. A total of 13 patients had suffered a traumatic SCI (T11:n = 2; T12:n = 5; L1:n = 5; L2:n = 1), while one developed stress incontinence after spinal surgery. The mean age was 41 years (range 26-69 years) and the mean duration of injury was 9.6 years (range 1.5-48 years). The preoperative investigations included video cystometrogram (VCMG) confirming the presence of urodynamically proven stress incontinence without evidence of urge incontinence. Complete cure was defined as a cessation of pad usage with no evidence of leakage on VCMG. Incomplete cure with improvement was defined as a > 50% reduction in the number of pads used, with incontinence present on VCMG. Results: The follow-up ranged from 12 to 58 months (mean 34.7 months). Five patients (36%) reported complete success, confirmed by VCMG. Three patients (21%) reported improvement with >50% reduction in the use of pads. The procedure failed completely in six patients (43 %). No immediate or late complications were noted with the procedure. Conclusions: The use of PDS is a safe and minimally invasive treatment for genuine stress urinary incontinence in males following SCI with a stable compliant bladder. We achieved complete cure in 36% of our patients with confirmation on VCMG. A further 21% reported greater than 50% reduction in usage of pads; however, on VCMG stress incontinence was demonstrated in these patients. We suggest that PDS can be used as the first line of treatment in this difficult group of patients with complex problems.