Erosion of bladder neck bulking: first case series of Macroplastique complications
BAUS ePoster online library. Jaffer A. 06/25/19; 259564; P7-1
Mr. Ata Jaffer
Mr. Ata Jaffer
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Abstract
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INTRODUCTION

Several urethral bulking agents currently exist with most demonstrating promising short term outcomes in terms of efficacy and safety, however long term data is limited. Macroplastique (polydimethylsiloxane injection) was one of the earlier agents used and deemed to be one the safest in systematic reviews however in this case series, we present a number of patients who were treated at our national salvage centre with complications.

Patients and Materials
Review of prospectively maintained database for patients presenting with complications of Macroplastique 2014-2018.

Results

A total of 9 patients were identified. Dates of original insertion ranged between 2002–2005. All patients were referred due to complaints of recurrent UTI's/pain and found to have erosion of the implant +/- calcification. A full assessment was carried out which included cystoscopy and pelvic MRI. All patients underwent transurethral resection of implant. 7 patients had complete resolution of symptoms with 2 requiring repeat resection. 2 had recurrent SUI successfully treated with an autologous sling and a further 2 patients are awaiting follow up.

Conclusions
To our knowledge, this is the first reported case series of Macroplastique related erosions. On cystoscopy they appear as yellow, spongiform protrusion and can be difficult to spot. Monopolar resection is challenging due to the insulating property of its silicone make-up therefore bipolar resection may be preferred. Following resection, our patients had significant improvement in symptoms and therefore it is important to remain vigilant of the possibility of erosion in patients with UTI's who have previously had an implant.

INTRODUCTION

Several urethral bulking agents currently exist with most demonstrating promising short term outcomes in terms of efficacy and safety, however long term data is limited. Macroplastique (polydimethylsiloxane injection) was one of the earlier agents used and deemed to be one the safest in systematic reviews however in this case series, we present a number of patients who were treated at our national salvage centre with complications.

Patients and Materials
Review of prospectively maintained database for patients presenting with complications of Macroplastique 2014-2018.

Results

A total of 9 patients were identified. Dates of original insertion ranged between 2002–2005. All patients were referred due to complaints of recurrent UTI's/pain and found to have erosion of the implant +/- calcification. A full assessment was carried out which included cystoscopy and pelvic MRI. All patients underwent transurethral resection of implant. 7 patients had complete resolution of symptoms with 2 requiring repeat resection. 2 had recurrent SUI successfully treated with an autologous sling and a further 2 patients are awaiting follow up.

Conclusions
To our knowledge, this is the first reported case series of Macroplastique related erosions. On cystoscopy they appear as yellow, spongiform protrusion and can be difficult to spot. Monopolar resection is challenging due to the insulating property of its silicone make-up therefore bipolar resection may be preferred. Following resection, our patients had significant improvement in symptoms and therefore it is important to remain vigilant of the possibility of erosion in patients with UTI's who have previously had an implant.

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