A. Chernoff et al., PERIURETHRAL COLLAGEN INJECTION FOR THE TREATMENT OF URINARY-INCONTINENCE IN CHILDREN, The Journal of urology, 157(6), 1997, pp. 2303-2305
Purpose: We assessed the efficacy and safety of periurethral collagen
injection for urinary incontinence in children with neurogenic bladder
dysfunction. Materials and Methods: We treated 11 children (mean age
10.6 years) who had incontinence and neurogenic bladder dysfunction wi
th periurethral injections of glutaraldehyde cross-linked collagen. Al
l patients were on anticholinergics and all but 1 were on clean interm
ittent catheterization preoperatively. Four patients had previously un
dergone augmentation cystoplasty. All patients were assessed before an
d after injection with a subjective continence scale and multichannel
urodynamics. Followup ranged from 4 to 20 months from the last injecti
on. Results: Mean group Valsalva leak point pressure was 34.5 cm. wate
r. Four of the 11 patients had an identifiable detrusor leak point pre
ssure. Overall success rate was 55% with 4 patients dry and 2 improved
. Success correlated with a minimum increase in Valsalva leak point pr
essure of 20 to 25 cm. water to greater than 60 cm. water. Three patie
nts had no demonstrable Valsalva leak point pressure after injection.
All 5 patients in whom treatment failed had no change in Valsalva leak
point pressure, including 2 with small capacity, poorly compliant bla
dders preoperatively. Because they had a component of sphincteric insu
fficiency, they underwent injection in the hope of increasing capacity
with increased continence. In 3 patients Valsalva leak point pressure
was greater than 50 cm. water. Detrusor leak point pressure developed
in 3 patients postoperatively, including 1 with significantly increas
ed Valsalva leak point pressure. One patient with significantly increa
sed Valsalva leak point pressure had urethral hypermobility postoperat
ively. Of the 3 patients who subsequently underwent augmentation cysto
plasty 1 is now dry, 1 is wet and 1 died of complications unrelated to
urological disease. Patients underwent 1 to 4 procedures (mean 2.5).
Conclusions: Periurethral collagen injection may be effective for urin
ary incontinence in patients who have adequate capacity with good comp
liance and low Valsalva leak point pressure. When there is no response
to repeat injections or a transient response, one should consider the
possibility of bladder decompensation.