Glutaraldehyde cross-linked collagen in the treatment of urinary incontinence in children
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M D Bomalaski1, D A Bloom, E J McGuire
1Section of Urology, University of Michigan, Ann Arbor, USA.
Insights
Glutaraldehyde cross-linked collagen effectively treats pediatric urinary incontinence, improving continence in most cases. This durable treatment shows lasting benefits, particularly for exstrophy/epispadias complex patients.
Area of Science:
- Urology
- Biomaterials Science
Background:
- Pediatric structural urinary incontinence presents significant challenges.
- Effective and durable treatment options are crucial for improving quality of life.
Purpose of the Study:
- To evaluate the efficacy and durability of glutaraldehyde cross-linked collagen injections for pediatric structural urinary incontinence.
- To assess outcomes in different pediatric patient groups, including those with spina bifida and exstrophy/epispadias complex.
Main Methods:
- Prospective analysis of 40 pediatric patients with structural urinary incontinence.
- Inclusion of urodynamic evaluation, continence grade, pad use, and dry interval assessments.
- Patient satisfaction surveys focusing on self-esteem, activity, and overall benefit.
Main Results:
- Complete cure in 22%, improvement in 54% of patients.
- Statistically significant improvements in continence grade, pad use, and dry interval for exstrophy/epispadias and spina bifida groups.
- Higher success rates observed in exstrophy/epispadias complex (91%) compared to spina bifida (71%).
- No adverse effects on bladder safety pressures.
- Long-term durability demonstrated, with sustained improvement rates over 4.5 years.
Conclusions:
- Glutaraldehyde cross-linked collagen is an effective treatment for anatomically based pediatric urinary incontinence.
- Exstrophy/epispadias patients experience the best outcomes with collagen treatment.
- The collagen treatment demonstrates durability in patients with initially positive results.
Purpose:
Prospective analysis was done to assess the efficacy of glutaraldehyde cross-linked collagen in the treatment of pediatric structural urinary incontinence.
Materials And Methods:
A total of 40 pediatric patients (average age 12.1 years) with structural urinary incontinence received 70 glutaraldehyde cross-linked collagen injections. Of the 40 patients 25 had spina bifida, 12 had the exstrophy/epispadias complex, 2 had continent reservoirs and 1 had bilateral ureteral ectopia. Average followup was 2.1 years (range 3 months to 6.3 years), and included urodynamic evaluation and assessment of change in continence grade, daily pad use and dry interval. Patient satisfaction was evaluated by questionnaire concerning self-esteem, activity level and patient assessment of overall benefit.
Results:
Complete cure of incontinence was reported by 22% of patients, improvement by 54% and no change by 24%. There was statistically significant postoperative improvement of continence grade (exstrophy/epispadias p < or = 0.004, spina bifida p < or = 0.0001), decreased daily use of pads (exstrophy/epispadias p < or = 0.008, spina bifida p < or = 0.002) and dry interval (exstrophy/epispadias p < or = 0.008, spina bifida p < or = 0.004). Greater success occurred in cases of the exstrophy/epispadias complex (91%) than spina bifida (71%). No patient had unsafe bladder pressures as a result of collagen treatment. Reevaluation of a 1992 study group with an initial 88% cure or improvement rate showed that after a mean followup of 4.5 years the cure or improvement rate remained 86%.
Conclusions:
Collagen improves continence in the majority of children with anatomically based urinary incontinence. Exstrophy/epispadias patients have the best outcome from collagen treatment. Glutaraldehyde cross-linked collagen is durable in most patients who have an initially positive outcome.