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Collagen injection for treatment of urinary incontinence in children
W Kassouf1, G Capolicchio, G Berardinucci
1McGill University and Shriners Hospital, Montreal, Quebec, Canada.
Insights
Periurethral collagen injection for pediatric neurogenic bladder incontinence shows low long-term success. Most patients experienced initial improvement that deteriorated, indicating limited effectiveness for neurogenic sphincter deficiency.
Area of Science:
- Pediatric Urology
- Urodynamics
- Minimally Invasive Surgery
Background:
- Neurogenic bladder dysfunction in children, often due to myelomeningocele, leads to urinary incontinence.
- Sphincter deficiency is a common cause of incontinence in this population.
- Periurethral injection aims to improve sphincter function and continence.
Purpose of the Study:
- To evaluate the long-term success rate of endoscopic periurethral collagen injection.
- To assess its efficacy in treating urinary incontinence in children with neurogenic bladder dysfunction secondary to myelomeningocele.
Main Methods:
- A cohort of 20 pediatric patients (15 male, 5 female) with spina bifida underwent collagen injection.
- Mean follow-up was 4.2 years, with pretreatment urodynamic assessment.
- Concurrent medical management and prior surgical history were noted.
Main Results:
- Most patients (16/20) reported no change in continence, with only 1 patient achieving complete dryness.
- Initial improvement was observed in some patients within 2 months post-injection.
- This initial benefit deteriorated over time in the majority of cases.
Conclusions:
- The study does not support previously reported high success rates for periurethral collagen injection.
- Long-term follow-up reveals that collagen injection is rarely effective for pediatric neurogenic incontinence due to sphincter deficiency.
- Alternative or adjunctive treatments may be necessary for sustained continence.
Purpose:
We assess the success rate of periurethral collagen injection in children with neurogenic bladder dysfunction secondary to myelomeningocele.
Materials And Methods:
From 1992 to 1998, 15 male and 5 female patients with spina bifida (age 13.3 +/- 3.8 years) underwent endoscopic collagen injection for the treatment of urinary incontinence secondary to sphincter deficiency. Mean followup was 4.2 years. Pretreatment urodynamic study showed a stable compliant bladder with an average leak point pressure of 52 cm. H2O (range 23 to 100). Concurrent medical management included anticholinergics in 15 cases, agonists in 3, and clean intermittent catheterization in 16. Five patients had undergone previous ileocystoplasty.
Results:
Collagen injections were given with the patient under general anesthesia. The number of injections was 1 in 5 cases, 2 in 11, 3 in 3, and 4 in 1. Average collagen volume injected per treatment was 6.6 cc (range 2 to 13). All patients were evaluated on a subjective continence scale of no change (wet), improved or completely dry at the time of assessment. Of the 20 patients, 16 had no change, 3 showed improvement and 1 was dry. Initial improvement in the first 2 months after injection deteriorated thereafter in 16 cases.
Conclusions:
The previously reported high success rate of collagen injection is not supported by this study. With long-term followup collagen injection is rarely effective for treating urinary incontinence in children with neurogenic sphincter deficiency.
