Outcome results of transurethral collagen injection for female stress incontinence: Assessment by urinary incontinence score

Purpose: We assessed the results of collagen injection for female sphincter ic incontinence using strict subjective and objective criteria. Materials and Methods: We evaluated 63 consecutive women with sphincteric i ncontinence who underwent a total of 131 transurethral collagen injections. Sphincteric incontinence was confirmed by urodynamics. All patients were t reated with 1 to 5 transurethral collagen injections and treatment outcome was classified according to a new outcome score. Cure was defined as no uri nary loss due to urge or stress incontinence documented by a 24-hour diary and pad test, and patient assessment that cure was achieved. Failure was de fined as poor objective results and patient assessment that treatment faile d. Cases that did not fulfill these cure and. failure criteria were conside red improved and further classified as a good, fair or poor response. Results: Mean patient age plus or minus standard deviation was 67.7 +/- 12. 8 years. All women had a long history of severe stress urinary incontinence , 18 (29%) underwent previous anti-incontinence surgery, and 41% had combin ed stress and urge incontinence. Preoperatively diary and pad tests reveale d a mean of 7.5 +/- 4.6 incontinence episodes and 152 +/- 172 gm. of urine lost per 24 hours. Overall 1 to 5 injections were given in 26, 17, 13, 3 an d 4 patients, respectively. Mean interval between injections was 4.4 +/- 5. 7 months, mean followup was 12 +/- 9.6 months, and mean interval between th e final injection and outcome assessment was 6.4 +/- 4.9 months, There was a statistically significant decrease in the total number of incontinence ep isodes per 24-hour voiding diary after each injection session. Although the re was a clear trend toward decreased urinary loss per 24-hour pad test, st atistical significance was not established. Using the strict criteria of ou r outcome score overall 13% of procedures were classified as cure, 10%, 17% and 42% as good, fair and poor, respectively, and 18% as failure. Conclusions: As defined by strict subjective and objective criteria, we not ed a low short-term cure rate after collagen injection in women with severe sphincteric incontinence. It remains to be determined how patients with le ss severe incontinence would fare using our outcome assessment instruments.