SUBMUCOSAL BLADDER NECK INJECTIONS OF GLUTARALDEHYDE CROSS-LINKED BOVINE COLLAGEN FOR THE TREATMENT OF URINARY-INCONTINENCE IN PATIENTS WITH THE EXSTROPHY EPISPADIAS COMPLEX/

During the last 7 years 19 patients underwent 33 transurethral injecti ons of glutaraldehyde cross-linked bovine collagen into the bladder ne ck for stress incontinence. Of the 15 patients 14 have classic bladder exstrophy, 3 have complete male epispadias and 2 have cloacal exstrop hy. The procedure was performed after a Young-Dees-Leadbetter bladder neck reconstruction in 15 patients and before it in 4. Injections were repeated in 10 patients after a mean of 12 months. After a mean follo wup of 26 months (range 9 to 84) improvement of continence was noted i n 10 of 19 patients (53%) of whom 4 have significant improvement. Of t he 8 patients whose condition failed to improve after collagen injecti ons 6 underwent additional successful surgery to achieve urinary conti nence. Of the 10 patients who underwent repeated collagen injections 9 (90%) had additional improvement. Although there were no complication s related to the injected collagen itself, postoperative complications developed in 2 patients. Submucosal injection of collagen to the blad der neck is simple and safe, and has a reasonable success rate. Thus, it may be used to improve continence in patients with the exstrophy/ep ispadias complex who lack full control after appropriate reconstructiv e surgery.