title: Treatment of urinary incontinence in children by endoscopically directed bladder neck injection of collagen.
abstract: OBJECTIVE
  We assessed optimal selection criteria for and expected outcome of bladder neck injection of collagen in children with intrinsic sphincteric deficiency.
  
  
  METHODS
  We retrospectively reviewed the charts of children with intrinsic sphincteric deficiency treated with bladder neck injection of collagen at 3 pediatric urology centers.
  
  
  RESULTS
  We reviewed the records of 12 boys and 6 girls 6 to 18 years old (median age 10.5). The underlying etiology of incontinence was neurogenic bladder in 10 patients, the epispadias-exstrophy complex in 6, ureterocele in 1 and trauma in 1. Previous surgery included bladder augmentation in 4 cases, bladder neck plasty in 7 and epispadias repair in 4, and concurrent medical management comprised anticholinergics in 8, alpha-agonists in 1 and intermittent catheterization in 9. Skin tests in all patients were negative for collagen. Seven patients had 1 injection, 9 had 2 and 2 had 3. The volume of collagen injected ranged from 2.4 to 13 cc (median 5) per treatment and 3 to 28 cc (median 7) per patient. Followup ranged from 5 to 21 months (median 15). Of the 14 patients evaluated 5 are dry, 4 are improved, 1 is unchanged and 4 underwent further continence surgery. No treatment related morbidity was seen.
  
  
  CONCLUSIONS
  Endoscopically directed injection of collagen around the bladder neck is successful in 64% of children with intrinsic sphincteric deficiency. It is an outpatient treatment with no significant morbidity. Further continence surgery is not precluded when necessary. Patients with adequate capacity and compliant neurogenic bladders, and those with the exstrophy-epispadias complex and failed bladder neck plasty seem to be optimal candidates for collagen injection.
authors.affiliation: University of Manitoba, Winnipeg, Canada.
authors.forename: M P
authors.initials: MP
authors.lastname: Leonard
authors.forename: A
authors.initials: A
authors.lastname: Decter
authors.forename: L W
authors.initials: LW
authors.lastname: Mix
authors.forename: H W
authors.initials: HW
authors.lastname: Johnson
authors.forename: G U
authors.initials: GU
authors.lastname: Coleman
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D002648:Child; D003094:Collagen / Q000008:administration & dosage*; D003432:Cross-Linking Reagents / Q000008:administration & dosage*; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000628:therapy*
chemical_list: D003432:Cross-Linking Reagents; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen