Md. Bomalaski et al., GLUTARALDEHYDE CROSS-LINED COLLAGEN IN THE TREATMENT OF URINARY-INCONTINENCE IN CHILDREN, The Journal of urology, 155(2), 1996, pp. 699-702
Purpose: Prospective analysis was done to assess the efficacy of gluta
raldehyde cross-linked collagen in the treatment of pediatric structur
al urinary incontinence. Materials and Methods: A total of 40 pediatri
c patients (average age 12.1 years) with structural urinary incontinen
ce received 70 glutaraldehyde cross-linked collagen injections. Of the
40 patients 25 had spina bifida, 12 had the exstrophy/epispadias comp
lex, 2 had continent reservoirs and 1 had bilateral ureteral ectopia.
Average followup was 2.1 years (range 3 months to 6.3 years), and incl
uded urodynamic evaluation and assessment of change in continence grad
e, daily pad use and dry interval. Patient satisfaction was evaluated
by questionnaire concerning self-esteem, activity level and patient as
sessment of overall benefit. Results: Complete cure of incontinence wa
s reported by 22% of patients, improvement by 54% and no change by 24%
. There was statistically significant postoperative improvement of con
tinence grade (exstrophy/epispadias p less than or equal to 0.004, spi
na bifida p less than or equal to 0.0001), decreased daily use of pads
(exstrophy/epispadias p less than or equal to 0.008, spina bifida p l
ess than or equal to 0.002) and dry interval (exstrophy/epispadias p l
ess than or equal to 0.008, spina bifida p less than or equal to 0.004
). Greater success occurred in cases of the exstrophy/epispadias compl
ex (91%) than spina bifida (71%). No patient had unsafe bladder pressu
res as a result of collagen treatment. Reevaluation of a 1999 study gr
oup with an initial 88% cure or improvement rate showed that after a m
ean followup of 4.5 years the cure or improvement rate remained 86%. C
onclusions: Collagen improves continence in the majority of children w
ith anatomically based urinary incontinence. Exstrophy/epispadias pati
ents have the best outcome from collagen treatment. Glutaraldehyde cro
ss-linked collagen is durable in most patients who have an initially p
ositive outcome.