title: New onset vesicovaginal fistula after transurethral collagen injection in women who underwent cystectomy and orthotopic neobladder creation: presentation and definitive treatment.
abstract: OBJECTIVE
  We present our experience with collagen injection for treating urinary incontinence after cystectomy and orthotopic bladder substitution in women. We discuss the efficacy of collagen injection, specific complications and subsequent definitive therapy.
  
  
  METHODS
  We performed cystectomy and orthotopic bladder substitution in 2 women for muscle invasive transitional cell carcinoma of the bladder. In each case new onset stress urinary incontinence developed after surgery that was refractory to conservative therapy. Intrinsic sphincter deficiency was diagnosed in each patient by video urodynamic studies. Initial treatment involved transurethral collagen injections but subsequent intervention was required due to resultant complications and primary therapy inefficacy.
  
  
  RESULTS
  Collagen (3.5 cc per session) was injected in 1 case at 2 treatment sessions and in the other at 3. Incontinence symptoms did not significantly improve in either patient and a new onset vesicovaginal fistula developed 2 days and 1 month after collagen injection, respectively. Subsequently in each case 1-stage transvaginal primary fistula repair was done in multiple layers with a pubovaginal sling procedure. Six months after repair there has been no recurrent fistula and the women remain hypercontinent, requiring intermittent self-catheterization. They are satisfied with their eventual lower tract function and overall outcome.
  
  
  CONCLUSIONS
  Collagen injection for type 3 stress urinary incontinence after cystectomy and orthotopic bladder replacement in women may not be as effective and innocuous as in patients with a native bladder. Initial treatment with a pubovaginal sling procedure should be considered.
authors.affiliation: Division of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Pruthi
authors.forename: C D
authors.initials: CD
authors.lastname: Petrus
authors.forename: J R
authors.initials: JR
authors.lastname: Bundrick WS
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D003094:Collagen / Q000627:therapeutic use*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000628:therapy*; D014563:Urodynamics; D014719:Vesicovaginal Fistula / Q000209:etiology*
chemical_list: D003094:Collagen