title: Submucosal bladder neck injection of bovine dermal collagen for stress urinary incontinence in the pediatric population.
abstract: OBJECTIVE
  The surgical management of stress urinary incontinence in the pediatric population includes various surgical techniques of which the simplest is outpatient transurethral or periurethral injection of a bulking agent. Currently purified bovine dermal collagen cross-linked with glutaraldehyde (Contigen) is the only Food and Drug Administration approved bulking agent available. Patients with stable detrusor function are ideal candidates. We review our initial experience with children.
  
  
  METHODS
  Between January 1994 and June 1995, 23 boys and 9 girls 4 to 17 years old (mean age 9) consecutively underwent submucosal bladder neck injection with cross-linked bovine dermal collagen. Incontinence was secondary to spinal dysraphism in 24 patients, complete epispadias in 4, classic bladder exstrophy in 3 and neurogenic bladder secondary to a sacral teratoma in 1. Preoperative video urodynamics documented intrinsic sphincteric deficiency in all patients with leak point pressure of 15 to 60 cm. water (mean 37). Injection volumes ranged from 2.5 to 17 cc (mean 10). Continence results were defined as dry-requiring no protection while on a 4-hour clean intermittent catheterization program, good-improved but requiring 1 to 5 pads daily and failure-no postoperative improvement or still requiring diapers.
  
  
  RESULTS
  Of the children with neurogenic bladder 20% became dry following the first injection and an additional 28% had a good result. Furthermore, of the 6 children with exstrophy or epispadias who underwent a Young-Dees-Leadbetter procedure 50% were dry and 17% had a good result after the first injection. Complications were limited to a febrile urinary tract infection associated with urinary retention in 1 patient and transiently worse continence in 2.
  
  
  CONCLUSIONS
  Despite the limited success rate, we believe that transurethral collagen injection therapy has a viable role in the treatment of intrinsic sphincteric deficiency in select pediatric patients, particularly since the procedure has low morbidity and can be performed on an outpatient basis. Preoperative counseling should be given with realistic expectations.
authors.affiliation: Division of Urology, Emory University, Egleston Children's Hospital, Atlanta, Georgia, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Pérez
authors.forename: E A
authors.initials: EA
authors.lastname: Smith
authors.forename: T S
authors.initials: TS
authors.lastname: Parrott
authors.forename: B H
authors.initials: BH
authors.lastname: Broecker
authors.forename: C A
authors.initials: CA
authors.lastname: Massad
authors.forename: J R
authors.initials: JR
authors.lastname: Woodard
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D000818:Animals; D002417:Cattle; D002648:Child; D003094:Collagen / Q000008:administration & dosage*; D003432:Cross-Linking Reagents / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D009092:Mucous Membrane; D014550:Urinary Incontinence, Stress / Q000628:therapy*
chemical_list: D003432:Cross-Linking Reagents; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen