Collagen injection therapy for post-prostatectomy incontinence.
OBJECTIVE
Post-prostatectomy incontinence has an incidence of 5 to 12% and greatly affects quality of life. Since the approval of glutaraldehyde cross-linked collagen there is a renewed interest in injectable urethral bulking agents. We investigated the long-term efficacy and prognostic criteria for transurethral collagen injection therapy for men with post-prostatectomy incontinence.


METHODS
From November 1993 to May 1995, 62 men with post-prostatectomy incontinence (54 after radical prostatectomy and 8 after transurethral resection of the prostate) were treated with collagen via a transurethral approach. Median followup was 29.0 months from the date of the last injection procedure.


RESULTS
Social continence was defined as dry or minimal leakage requiring at most 1 pad daily with activity. Of 62 patients 38.7% achieved social continence and 8.1% became totally dry. The success rate was 35.2 for radical prostatectomy versus 62.5% for transurethral prostatic resection patients. Of the patients who achieved social continence with at least 1-year followup 23 (60.9%) remained so with no further treatment. At 2-year followup 21 patients (42.8%) maintained social continence. The success rate was 27.3% for those who wore a penile clamp or condom catheter before treatment (3 of 11 patients), and only 21.4% for those who underwent transurethral incision of a bladder neck contracture (3 of 14). A median of 4 injection procedures and 20.0 ml. collagen were required to achieve social continence.


CONCLUSIONS
Transurethral collagen injection therapy is a reasonable treatment option for post-prostatectomy incontinence in select patients in whom more conservative therapy has failed. However, patients who have required a penile clamp, experienced continuous leakage or undergone transurethral incision of a bladder neck contracture are unlikely to respond well to this treatment.
Department of Urology, The Cleveland Clinic Foundation, Ohio 44195, USA.
D N
DN
Smith
R A
RA
Appell
R R
RR
Rackley
J C
JC
Winters
D000203:Activities of Daily Living; D000368:Aged; D003094:Collagen / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D003250:Constriction; D003286:Contracture / Q000601:surgery; D003432:Cross-Linking Reagents / Q000737:chemistry; D005500:Follow-Up Studies; D005976:Glutaral / Q000737:chemistry; D006801:Humans; D015994:Incidence; D016496:Incontinence Pads; D007267:Injections; D008297:Male; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011788:Quality of Life; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery; D014546:Urinary Catheterization / Q000295:instrumentation; D014549:Urinary Incontinence / Q000628:therapy*
D003432:Cross-Linking Reagents; D003094:Collagen; D005976:Glutaral