PERCUTANEOUS ANTEGRADE COLLAGEN INJECTION THERAPY FOR URINARY-INCONTINENCE FOLLOWING RADICAL PROSTATECTOMY

Objectives, To determine the potential utility of glutaraldehyde cross -linked collagen (GAX-collagen) administered in an antegrade fashion i nto the submucosa of the bladder neck in patients who present with pos tprostatectomy urinary incontinence. Methods. Twenty-four men aged 59 to 76 years (mean 69.0) with stress type urinary incontinence after ra dical prostatectomy were evaluated in this study. All patients had pre viously received retrograde collagen (mean number of treatments 4.33; amount of collagen was 25.72 mt) and had failed to develop further imp rovement by this approach alone. These patients subsequently received antegrade collagen via a suprapubic approach. An average of 7.1 mt of GAX-collagen was used for the procedure. Results. Minimal follow-up wa s 12 months (range 12 to 15). Patients were considered cured if they w ere dry and wore no pads or were socially continent with less than one pad per day. Eighteen of 24 patients (75%) were dry at the 6-month fo llow-up. With longer follow-up at 12 months, however, only 9 of 24 pat ients (37.5%) were totally dry. All patients experienced symptomatic i mprovement as manifested by lower pad usage. Conclusions. With proper patient selection, antegrade administration of GAX-collagen in patient s who have failed standard retrograde collagen injection may salvage m any patients from eventual failure of the conservative treatment appro ach. As newer injectables become available, the overall results may im prove. Copyright 1996 by Elsevier Science Inc.