GLUTARALDEHYDE CROSS-LINED COLLAGEN IN THE TREATMENT OF URINARY-INCONTINENCE IN CHILDREN

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.