title: Glutaraldehyde cross-linked collagen in the treatment of urinary incontinence in children.
abstract: OBJECTIVE
  Prospective analysis was done to assess the efficacy of glutaraldehyde cross-linked collagen in the treatment of pediatric structural urinary incontinence.
  
  
  METHODS
  A total of 40 pediatric patients (average age 12.1 years) with structural urinary incontinence received 70 glutaraldehyde cross-linked collagen injections. Of the 40 patients 25 had spina bifida, 12 had the exstrophy/epispadias complex, 2 had continent reservoirs and 1 had bilateral ureteral ectopia. Average followup was 2.1 years (range 3 months to 6.3 years), and included urodynamic evaluation and assessment of change in continence grade, daily pad use and dry interval. Patient satisfaction was evaluated by questionnaire concerning self-esteem, activity level and patient assessment of overall benefit.
  
  
  RESULTS
  Complete cure of incontinence was reported by 22% of patients, improvement by 54% and no change by 24%. There was statistically significant postoperative improvement of continence grade (exstrophy/epispadias p < or = 0.004, spina bifida p < or = 0.0001), decreased daily use of pads (exstrophy/epispadias p < or = 0.008, spina bifida p < or = 0.002) and dry interval (exstrophy/epispadias p < or = 0.008, spina bifida p < or = 0.004). Greater success occurred in cases of the exstrophy/epispadias complex (91%) than spina bifida (71%). No patient had unsafe bladder pressures as a result of collagen treatment. Reevaluation of a 1992 study group with an initial 88% cure or improvement rate showed that after a mean followup of 4.5 years the cure or improvement rate remained 86%.
  
  
  CONCLUSIONS
  Collagen improves continence in the majority of children with anatomically based urinary incontinence. Exstrophy/epispadias patients have the best outcome from collagen treatment. Glutaraldehyde cross-linked collagen is durable in most patients who have an initially positive outcome.
authors.affiliation: Section of Urology, University of Michigan, Ann Arbor, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Bomalaski
authors.forename: D A
authors.initials: DA
authors.lastname: Bloom
authors.forename: E J
authors.initials: EJ
authors.lastname: McGuire
authors.forename: A
authors.initials: A
authors.lastname: Panzl
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003094:Collagen; D003432:Cross-Linking Reagents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014550:Urinary Incontinence, Stress / Q000628:therapy*
chemical_list: D003432:Cross-Linking Reagents; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen