ADVERSE PROGNOSTIC FEATURES OF COLLAGEN INJECTION THERAPY FOR URINARY-INCONTINENCE FOLLOWING RADICAL RETROPUBIC PROSTATECTOMY

Purpose: We identified and characterized predictive factors associated with an unfavorable outcome of collagen injection therapy in post-rad ical prostatectomy incontinence. Materials and Methods: A total of 46 patients, 49 to 85 years old (mean age 67) and incontinent after radic al retropubic prostatectomy, underwent a mean of 2.8 transurethral inj ections of collagen (mean cumulative volume injected 31 mi.), Preopera tively, all patients underwent fluoroscopic multichannel video urodyna mics including determination of Valsalva's leak point pressure, Stress urinary incontinence was subjectively graded as 1 (0 to 1 pad per day ), 2 (2 to 3 pads per day) and 3 (greater than 3 pads per day). Patien t age, duration and severity of pretreatment incontinence, presence of detrusor instability and anastomotic strictures, number of injections , total volume of collagen delivered and the impact of a nerve sparing procedure plus adjuvant radiation therapy were assessed and correlate d with treatment outcome. Results: Of the patients 11 (24%) became com pletely dry (9 after 3 or fewer treatments), 21 (41%) improved (17 aft er 3 or fewer treatments) and 14 (30%) showed no benefit (after more t han 3 treatments), Of the 14 patients in whom treatment failed 6 had u ndergone adjuvant radiation treatment, pretreatment urinary incontinen ce was grade 3 in all, and concomitant detrusor instability was presen t in 11 (79%). All patients had received more than 3 treatments (mean total volume injected 37 mi.). Conclusions: Notwithstanding the need f or multiple treatments, the prospect for cure by collagen injection of the post-radical prostatectomy incontinent patient is significantly a ffected by the severity of pretreatment incontinence, concomitant detr usor overactivity and exposure to radiation therapy. Age, duration of incontinence, presence of mild to moderate anastomotic strictures and a nerve sparing technique did not seem to influence treatment outcome.