COLLAGEN INJECTION THERAPY FOR POSTPROSTATECTOMY INCONTINENCE

Purpose: Post-prostatectomy incontinence has an incidence of 5 to 12% and greatly affects quality of life. Since the approval of glutaraldeh yde cross-linked collagen there is a renewed interest in injectable ur ethral bulking agents. We investigated the long-term efficacy and prog nostic criteria for transurethral collagen injection therapy for men w ith post-prostatectomy incontinence. Materials and Methods: From Novem ber 1993 to May 1995, 62 men with post-prostatectomy incontinence (54 after radical prostatectomy and 8 after transurethral resection of the prostate) were treated with collagen via a transurethral approach. Me dian followup was 29.0 months from the date of the last injection proc edure. Results: Social continence was defined as dry or minimal leakag e requiring at most 1 pad daily with activity. Of 62 patients 38.7% ac hieved social continence and 8.1% became totally dry. The success rate was 35.2 for radical prostatectomy versus 62.5% for transurethral pro static resection patients, Of the patients who achieved social contine nce with at least 1-year followup 23 (60.9%) remained so with no furth er treatment. At 2-year followup 21 patients (42.8%) maintained social continence. The success rate was 27.3% for those who wore a penile cl amp or condom catheter before treatment (3 of 11 patients), and only 2 1.4% for those who underwent transurethral incision of a bladder neck contracture (3 of 14), A median of 4 injection procedures and 20.0 ml. collagen were required to achieve social continence. Conclusions: Tra nsurethral collagen injection therapy is a reasonable treatment option for post-prostatectomy incontinence in select patients in whom more c onservative therapy has failed. However, patients who have required a penile clamp, experienced continuous leakage or undergone transurethra l incision of a bladder neck contracture are unlikely to respond well to this treatment.