CORRELATION OF URODYNAMIC RESULTS AND URETHRAL COAPTATION WITH SUCCESS AFTER TRANSURETHRAL COLLAGEN INJECTION

Objectives. We correlated preoperative urodynamic and intraoperative e ndoscopic findings with initial improvement, single collagen injection effectiveness for intrinsic sphincter deficiency (ISD), and long-term improvement following transurethral collagen injection for stress uri nary incontinence (SUI). Methods. Since 1993, 79 patients have been tr eated with transurethral collagen injection by the same urologist. Of these patients, intraoperative photographs of urothelial coaptation im mediately after injection were available in 67 patients: 35 women with ISD, 24 men with incontinence, primarily following prostatectomy, and 8 children with neurogenic bladder. Urothelial coaptation was describ ed as snug, fair, or poor. Preoperative Valsalva leak point pressure ( VLPP), detrusor instability, impaired bladder compliance, bladder neck appearance, urothelial scarring, and degree of coaptation were correl ated with both initial and long-term improvement. Initial improvement was compared with long-term improvement. Results. Initial improvement was experienced by 85% of all the subjects (86% of the women, 80% of t he men, and 100% of the children with a neurogenic bladder condition). Overall, 31% of patients had long-term improvement after a mean follo w-up of 2.2 years, including 43% of the women, 13% of the men, and 33% of the children. The patients underwent a mean of 1.5 (1 to 4) collag en injections. There was a significant correlation between degree of c oaptation and initial improvement (P = 0.003), but not with long-term improvement. There was no correlation between VLPP, detrusor instabili ty, impaired compliance, bladder neck appearance, or urethral scarring and initial improvement. There was no correlation between any paramet er and long-term improvement or between initial and long-term improvem ent. Conclusions. Initial endoscopic appearance following collagen inj ection predicted initial, but not long-term, improvement after one col lagen injection. Initial improvement was high in both men and women bu t decreased considerably over time, more so in men, and was not signif icantly correlated with long-term success. Urodynamic and endoscopic f indings do not predict long-term success following collagen injection. (C) 1997, Elsevier Science Inc. All rights reserved.