Polydimethylsiloxane in the Treatment of Sphincter Weakness Incontinence in Men with Spinal Cord Injury: Long-Term Follow-Up

Abstract

Objective: To assess the long-term effectiveness of polydimethylsiloxane (PDS, Macroplastique™) perisphincteric injections in treating male sphincter weakness incontinence (SWI) caused by spinal cord injury (SCI). Patients and methods: Fourteen male patients with SCI underwent PDS injection to the external urethral sphincter for SWI (mean age: 50.1 years; range: 32–79 years). A single surgeon at a specialist spinal injury unit managed all patients. Complete cure was defined as cessation of pad usage with no evidence of leakage on video cystometrogram (VCMG). Partial cure with improvement was defined as >50% reduction in the number of pads used with incontinence present on VCMG. Results: Twelve of the 14 patients had a mean (range) follow-up of 8.7 (6.8–10.5) years. One patient was lost to follow-up at 2 years and one other died at 19 months from an unrelated chest infection. Four patients required repeat injections. Cure was achieved in three patients (25%); two were completely dry at 7.5 years while one was partially dry at 8.7 years. The remaining nine patients required further interventions to achieve continence. Conclusion: The use of PDS can be contemplated as first-line treatment in SWI in SCI patients. The long-term effect can, however, be non-durable and repeat injections may be required.