ANTEGRADE TECHNIQUES OF COLLAGEN INJECTION FOR POSTPROSTATECTOMY STRESS URINARY-INCONTINENCE - THE WASHINGTON-UNIVERSITY EXPERIENCE

Treatment of sphincteric incontinence after radical retropubic prostat ectomy remains a clinical challenge. Antegrade techniques of collagen injection are a relatively new method for treatment of post-prostatect omy incontinence. Early experience with this approach has demonstrated improved outcomes compared to the traditional retrograde technique. O verall response rates of 70% cure or significant improvement compare f avorably with previously reported series. The theoretical advantages o f this method include improved visualization of vesicourethral anastom osis and improved access to the bladder neck. Furthermore, suprapubic catheter drainage avoids the risks of collagen molding around the cath eter. The use of a flexible cystoscope for this approach is a recent m odification. The smaller diameter of the flexible cystoscope has facil itated access and reduced anesthetic requirements. This system affords unimpeded delivery of collagen to regions of the bladder neck where t he submucosa accommodates the injectable agent. In addition, this moda lity allows more precise needle positioning to provide correct angle a nd depth of penetration into the submucosal plane. Short-term success rates of this procedure are encouraging and suggest that it may become the primary approach. While these antegrade techniques are more aggre ssive than the traditional retrograde approach, they are relatively si mple and draw upon principles familiar to all urologists. It is hoped that the new flexible antegrade approach will further improve our resu lts. Longer-term follow-up studies with larger numbers of patients wil l be required to see whether we can accomplish this goal.