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Glutaraldehyde cross-linked bovine collagen in exstrophy/epispadias complex
P Caione1, A Lais, M de Gennaro
1Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Cross-linked bovine collagen injections improved continence in children with bladder exstrophy and epispadias. This minimally invasive treatment increased bladder capacity, potentially avoiding major surgery.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Children with bladder exstrophy and epispadias often experience urinary incontinence.
- Previous surgical interventions like the Young-Dees operation may not fully restore continence.
- Small bladder capacity can be a significant challenge after lower urinary tract reconstruction.
Purpose of the Study:
- To evaluate the efficacy of cross-linked bovine collagen injections in improving urinary continence and bladder capacity in pediatric patients.
- To assess collagen injections as an alternative to augmentation cystoplasty for increasing bladder volume.
Main Methods:
- Endoscopic submucosal injection of cross-linked bovine collagen into the urethra or bladder neck.
- Injections were administered to children with epispadias, bladder exstrophy, and post-Young-Dees incontinence.
- Collagen was also injected before bladder neck surgery to enhance outlet resistance and bladder capacity.
Main Results:
- Continence improved in 9 out of 10 children treated after bladder neck surgery.
- Bladder capacity increased by an average of 47% over 2 years in 5 out of 6 children treated before reconstruction.
- One patient experienced a failure of the procedure.
Conclusions:
- Submucosal collagen injection is a valuable tool for modulating outflow resistance and increasing bladder volume in pediatric patients.
- This technique offers a potential alternative to augmentation cystoplasty for patients with small bladders post-exstrophy closure.
Abstract:
We injected endoscopically 0.75 to 2.5 cc of cross-linked bovine collagen at the 3, 9 and 12 o'clock positions of the urethra or bladder neck of 9 children with epispadias and 7 with exstrophy. This procedure was performed in 10 children who were still incontinent after a Young-Dees operation. In 6 girls collagen was injected submucosally before bladder neck surgery to increase outlet resistance and to gain bladder capacity. A repeat injection was given to 3 patients after 1 year. Continence improved in 9 of the 10 cases injected after surgery of the bladder neck. Of the 6 children who underwent collagen treatment before reconstruction of the lower urinary tract capacity increased an average of 47% in 2 years in 5 and the procedure failed in 1. Submucosal injection of collagen is helpful in modulating outflow resistance and increasing bladder volume after primary closure of exstrophic bladders. Patients with small bladders following closure, who would otherwise be candidates for augmentation cystoplasty, may gain adequate bladder size with collagen injection.