Periurethral collagen injection for stress incontinence with and without urethral hypermobility

Objective: To compare the use of periurethral collagen injection in the tre atment of female stress urinary incontinence due to intrinsic sphincter def iciency in women with and without urethral hypermobility. Methods: A retrospective review was performed of 60 periurethral collagen i njections performed on 40 consecutive women from January 1996 to December 1 997. A review of the office chart and operative notes was performed to obta in demographic, urodynamic, and procedural data. Outcome data were obtained by personal or telephone interview, using patients' subjective assessments including an analog satisfaction scale. Results: Nine of 40 patients (23%) had urethral hypermobility. Compared wit h patients without hypermobility, patients with hypermobility required a si milar number of procedures (a mean of 1.9 compared with 1.4, P = .13) and r equired similar amounts of collagen on the first injection (5.6 mL compared with 5.3 mL, P = .69). Preoperative urodynamic parameters wt re similar in both groups. Rates of subjective dryness were equivalent in patients with and without hypermobility at 1 month (76% and 46%, P = .24) and at 6 months (71% and 32%, P = .09) following initial injection. A post hoc power analy sis was performed to evaluate the primary study measures of continence at 1 and 6 months, and number of collagen injections. This revealed that a samp le size of 40 patients would be sufficient to detect a 2.5-fold difference in number of injections and a 3-fold difference in subjective dryness. Conclusion: Coexisting urethral hypermobility should not preclude the use o f collagen injections in women with stress urinary incontinence. (Obstet Gy necol 2000;95:327-31. (C) 2000 by The American College of Obstetricians and Gynecologists.).