Treatment of post-prostatectomy stress urinary incontinence with periurethral polytetrafluoroethylene paste injection.

Abstract

Periurethral injection of polytetrafluoroethylene (Teflon) paste was performed to treat moderate to severe stress urinary incontinence following prostatectomy. A total of 20 procedures was performed in 13 men, of whom 8 had previously undergone radical prostatectomy for prostate cancer and 5 had undergone transurethral electrocautery resection of the prostate for bladder outlet obstruction due to benign prostatic hyperplasia. All patients had significant stress urinary incontinence requiring a minimum of 2 pads wet daily. Between 16 and 20 cc polytetrafluoroethylene paste were injected initially transurethrally into the periurethral tissues in the region of the external sphincter. Of the 13 patients 7 underwent a second injection procedure with an additional 12 to 23 cc paste. Three men (23%) experienced a noticeable improvement in continence status, including 1 of 5 patients after transurethral electrocautery resection and 2 of 8 after radical prostatectomy. However, none of these men became completely dry or was able to eliminate completely the use of pads. Of the 13 patients 10 (77%) experienced no detectable improvement in continence status. Seven patients have now successfully undergone implantation of an artificial urinary sphincter without complication. With a minimum followup of 11 months in all patients and a maximum followup of 3 years, none has experienced any clinically detectable long-term side effects related to the polytetrafluoroethylene injection or evidence of particulate migration.