SUBMUCOSAL BLADDER NECK INJECTION OF BOVINE DERMAL COLLAGEN FOR STRESS URINARY-INCONTINENCE IN THE PEDIATRIC POPULATION

Purpose: The surgical management of stress urinary incontinence in the pediatric population includes various surgical techniques of which th e simplest is outpatient transurethral or periurethral injection of a bulking agent. Currently purified bovine dermal collagen cross-linked with glutaraldehyde (Contigen) is the only Food and Drug Administratio n approved bulking agent available. Patients with stable detrusor func tion are ideal candidates. We review our initial experience with child ren. Materials and Methods: Between January 1994 and June 1995, 23 boy s and 9 girls 4 to 17 years old (mean age 9) consecutively underwent s ubmucosal bladder neck injection with cross-linked bovine dermal colla gen. Incontinence was secondary to spinal dysraphism in 24 patients, c omplete epispadias in 4, classic bladder exstrophy in 3 and neurogenic bladder secondary to a sacral teratoma in 1. Preoperative video urody namics documented intrinsic sphincteric deficiency in all patients wit h leak point pressure of 15 to 60 cm. water (mean 37). Injection volum es ranged from 2.5 to 17 cc (mean 10). Continence results were defined as dry-requiring no protection while on a 4-hour clean intermittent c atheterization program, good-improved but requiring 1 to 5 pads daily and failure-no postoperative improvement or still requiring diapers. R esults: Of the children with neurogenic bladder 20% became dry followi ng the first injection and an additional 28% had a good result. Furthe rmore, of the 6 children with exstrophy or epispadias who underwent a Young-Dees-Leadbetter procedure 50% were dry and 17% had a good result after the first injection. Complications were limited to a febrile ur inary tract infection associated with urinary retention in 1 patient a nd transiently worse continence in 2. Conclusions: Despite the limited success rate, we believe that transurethral collagen injection therap y has a viable role in the treatment of intrinsic sphincteric deficien cy in select pediatric patients, particularly since the procedure has low morbidity and can be performed on an outpatient basis. Preoperativ e counseling should be given with realistic expectations.