Endoscopic treatment of sphincteric urinary incontinence in pediatric urology Hamdan AlHazmi, Diego Barrieras, Cédric Andres, Julie Franc-Guimond and Anne-Marie Houle Division of Pediatric Urology, Department of Surgery, CHU Sainte-Justine, Université de Montréal, Québec, Canada.

Introduction Type III urinary incontinence present dificult problem in pediatric urology due to its various etiologies Type III urinary incontinence present dificult problem in pediatric urology due to its various etiologies Since 30 years surgical and medical treatment considerably advanced Since 30 years surgical and medical treatment considerably advanced In spite of the combination of CIC, anticholinergic and various surgical operations, certain patients remain incontinent In spite of the combination of CIC, anticholinergic and various surgical operations, certain patients remain incontinent

Introduction The endoscopic treatment has the advantage of being minimally invasive and possible even after multiple vesical/ ureteral reconstructions The endoscopic treatment has the advantage of being minimally invasive and possible even after multiple vesical/ ureteral reconstructions We present our results with the endoscopic correction of the type III incontinence using Polydimethylsiloxane (Macroplastic®,Uroplasty Inc.) We present our results with the endoscopic correction of the type III incontinence using Polydimethylsiloxane (Macroplastic®,Uroplasty Inc.)

Material and Methods Retrospective study Retrospective study 14 patients 14 patients 10 boys and 4 girls 10 boys and 4 girls 8-13 years 8-13 years Inclusion criteria: Inclusion criteria: Incontinence of the type III pure or mixed Incontinence of the type III pure or mixed Leak point pressure LPP<20 cmH 2 0 Leak point pressure LPP<20 cmH 2 0 Failure of the medical and/or surgical treatment Failure of the medical and/or surgical treatment

Material and Methods The surgical technique: The surgical technique: Injection under direct vision in 3points (2,6 and 10 hours or 4,8 and 12 O'clock) Injection under direct vision in 3points (2,6 and 10 hours or 4,8 and 12 O'clock) Level of injections: Level of injections: : Bladder neck Girls: Bladder neck external sphincter or posterior urethra Boys: external sphincter or posterior urethra

Material and Methods Follow up: Follow up: Renal U/S and UDS: 3 and 12 months Renal U/S and UDS: 3 and 12 months Diary for CIC and Pad/ Diaper Diary for CIC and Pad/ Diaper

Material and Methods Success rate definition: Success rate definition: From ≥2 Diaper/day to ≤2 pads/day From ≥2 Diaper/day to ≤2 pads/day Increase the period of continence(x2) Increase the period of continence(x2)

Results 14 patients 14 patients 8 MMC 8 MMC 4 Bladder Exstrophy 4 Bladder Exstrophy 1 Cloacal Exstrophy 1 Cloacal Exstrophy 1 Urogenital sinus anomaly 1 Urogenital sinus anomaly 24 Procedures 24 Procedures Volume injected : 1,5 - 5 ml Volume injected : 1,5 - 5 ml

Results… Disease specific success rate:Disease specific success rate:

Results Total success rate

Results… LPP Pre and Post Injection:LPP Pre and Post Injection:

Results… Leak point pressure (LPP) cmH20Leak point pressure (LPP) cmH20

Results… ComplicationsComplications

Conclusions The endoscopic treatment of type III incontinence is offers another option in armentarium of the paediatric urologists The endoscopic treatment of type III incontinence is offers another option in armentarium of the paediatric urologists The procedure is relatively simple,minimally invasive and Safe The procedure is relatively simple,minimally invasive and Safe The short-term results are encouraging The short-term results are encouraging Long-term results with large cohort are necessary Long-term results with large cohort are necessary