Abstract General Information

Title

THE IMPACT OF BULKING AGENTS INJECTION IN CHILDREN WITH INCONTINENCE DUE TO NEUROGENIC BLADDER: A META-ANALYSIS.

Introduction and objective

Neurogenic bladder is a bladder dysfunction secondary to an impairment of nervous system, counting with myelomeningocele as one of the most frequent etiologies. The mainstay of best management is still contentious. This meta-analysis aims to evaluate the effects of bulking agents injection on neurogenic bladder pediatric patients incontinence.

Method

Were systematically searched PubMed, Embase, and Scopus for studies about the effects of bulking agents injection in incontinent patients, using the search strategy: ("bulking agents" OR "collagen injection" OR "dextranomer" OR "polydimethylsiloxane" ) AND ("bladder neck" OR "submucosal" OR "periurethral" OR "urethral obstruction") AND ("urinary incontinence" OR "neurogenic bladder") AND ("children"). Explored outcomes were: success rate, number of injections and previous treatment. Statistical analysis was performed using R software and heterogeneity, using I² statistic.

Results

Nine clinical trials and six observational studies were selected, with 369 patients, more than 40% were females, who underwent endoscopic injection of bulking agents. Main etiologies of neurogenic bladder was myelodysplasia, spina bifida and myelomeningocele. Mean age is 9.9 ranging from 9 to 14 years old. Follow-up ranged from 15 to 96 months. Statistical results of clinical trials were: previous treatments (OR: 0.33; 95% CI [0.26;0.40]; p<0,01;I²=79%), success rate (OR: 0.50; 95% CI [0.43;0.56]; p<0,01;I²=84%). Statistical results of observational studies were: previous treatment (OR: 0.84; 95% CI [0.80;0.88]; p<0,01;I²=98%), success rate (OR: 0.31; 95% CI [0.24;0.38]; p<0,01;I²=94%). When considering clinical trials and observational studies, results were: previous treatment (OR: 0.70; 95% CI [0.67;0.74]; p<0,01;I²=97%) and success rate (OR: 0.06; 95% CI [0.04;0.07]; p<0,01;I²=96%). Success rate was considered by dry results, although improvements were described in most studies.

Conclusion

Statistical analysis has shown that injection of bulking agents in children with incontinence due to neurogenic bladder can not be supported by this analysis. The importance of this study is to avoid ineffective procedures, seeking treatment for this comorbidity.