title: Injectable collagen for the treatment of fecal incontinence: long-term results.
abstract: BACKGROUND
  Fecal incontinence is a distressing condition that is difficult to treat. Injection of bulking agents has been used to treat passive fecal incontinence. However, no long-term results are available.
  
  
  OBJECTIVE
  The aim of this study was to assess the long-term clinical effectiveness of intra-anal injection of collagen for passive fecal incontinence.
  
  
  METHODS
  This research is a retrospective cohort study from a prospectively collected database
  
  
  METHODS
  This investigation took place in a high-volume tertiary colorectal department.
  
  
  METHODS
  All patients who underwent intra-anal injection of collagen for passive fecal incontinence with internal sphincter dysfunction between January 2006 and December 2009 were included in the study. Data including demographic details, preoperative anorectal physiology, and outcome measures were collected prospectively and maintained in a database
  
  
  METHODS
  The primary outcomes measured were the Cleveland Clinic Florida incontinence score and the responses to a subjective patient satisfaction questionnaire before the procedure and at subsequent follow-up visits. Data were analyzed by using SPSS v19.0.
  
  
  RESULTS
  One hundred patients (70 female; mean age, 61 years (range, 36-82)) were followed up for a minimum duration of 36 months. Fifty-six patients (56%) had an improvement in fecal incontinence score from a mean of 14 (range, 9-18) to a mean of 8 (range, 5-14). A total of 68% reported subjective improvement in symptoms. Thirty-eight patients (38%) required a repeat injection of collagen, and a further 15 patients required a third injection. The median interval between the first and final injection was 12 months (range, 4-16 months). Age was the only independent predictor of successful outcome (p = 0.032). There was no morbidity.
  
  
  CONCLUSIONS
  This study was limited by its nonrandomized retrospective design.
  
  
  CONCLUSIONS
  Injection of collagen into the internal anal sphincter is simple, safe, and effective in patients with passive fecal incontinence, although repeat injections are necessary in approximately half of the patients.
authors: The John Goligher Colorectal Unit, St James's University Hospital, Leeds, United Kingdom.
authors: S
authors: S
authors: Maslekar
authors: K
authors: K
authors: Smith
authors: D
authors: D
authors: Harji
authors: B
authors: B
authors: Griffiths
authors: P M
authors: PM
authors: Sagar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000187:drug effects* / Q000503:physiopathology; D015331:Cohort Studies; D003094:Collagen / Q000008:administration & dosage*; D005242:Fecal Incontinence / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D003094:Collagen