[Intraurethral Macroplastic injections in the treatment of urinary incontinence after prostatic surgery]

To evaluate the results and the place of a minimally invasive intraurethral injection technique designed to improve the efficacy of the urethral sphincter in urinary incontinence after prostatic surgery.

A prospective study of 26 Macroplastique injections performed in 15 patients with a mean age of 66.4 years (range: 54 to 78 years) was conducted over an 18-month period. Eleven patients received 2 injections. Prostatic surgery consisted of retropubic radical prostatectomy (9 cases), transurethral resection (4 cases) or open prostatectomy (2 cases). Three patients received pelvic irradiation. Evaluation at 1, 3 and 12 months consisted of clinical questionnaire and urodynamic assessment.

Rapid deterioration of the initial improvement was observed (40% success at 1 month; 71% at 3 months; 33% at 6 months; 26% at 12 months). No significant influence was demonstrated for post-prostatectomy radiotherapy, the patient's age, more proximal bladder dysfunction, severity of incontinence or preoperative status. However, better results were observed when the resting urethral closure pressure remained higher than 30 cm H2O.

We believe that intraurethral injections still have a place in the therapeutic armamentarium for incontinence after prostatic surgery with satisfactory initial results, which unfortunately deteriorate after 3 months. Our study confirms the value of Macroplastique compared to other substances. It is difficult to define the predictive factors of failure, but a closure pressure greater than 30 cm H2O remains essential. Finally, an interval of at least 3 months should be observed before repeating this procedure in the case of an insufficient result.