title: Submucosal bladder neck injections of glutaraldehyde cross-linked bovine collagen for the treatment of urinary incontinence in patients with the exstrophy/epispadias complex.
abstract: During the last 7 years 19 patients underwent 33 transurethral injections of glutaraldehyde cross-linked bovine collagen into the bladder neck for stress incontinence. Of the 15 patients 14 have classic bladder exstrophy, 3 have complete male epispadias and 2 have cloacal exstrophy. The procedure was performed after a Young-Dees-Leadbetter bladder neck reconstruction in 15 patients and before it in 4. Injections were repeated in 10 patients after a mean of 12 months. After a mean followup of 26 months (range 9 to 84) improvement of continence was noted in 10 of 19 patients (53%) of whom 4 have significant improvement. Of the 8 patients whose condition failed to improve after collagen injections 6 underwent additional successful surgery to achieve urinary continence. Of the 10 patients who underwent repeated collagen injections 9 (90%) had additional improvement. Although there were no complications related to the injected collagen itself, postoperative complications developed in 2 patients. Submucosal injection of collagen to the bladder neck is simple and safe, and has a reasonable success rate. Thus, it may be used to improve continence in patients with the exstrophy/epispadias complex who lack full control after appropriate reconstructive surgery.
authors.affiliation: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-2101, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ben-Chaim
authors.forename: R D
authors.initials: RD
authors.lastname: Jeffs
authors.forename: D S
authors.initials: DS
authors.lastname: Peppas
authors.forename: J P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003094:Collagen / Q000008:administration & dosage*; D004842:Epispadias / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D009092:Mucous Membrane; D019736:Prostheses and Implants; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000628:therapy*
chemical_list: C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen