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Incontinence in elderly women: is periurethral collagen an advance?
1Department of Obstetrics and Gynaecology, St George's Hospital, London, UK.
Objective:
To determine whether periurethral collagen is an effective, safe and practical day-case procedure to control genuine stress incontinence (urethral sphincter incompetence) in the elderly female.
Design:
Prospective longitudinal study using subjective and objective outcome measures with long term follow up.
Setting:
A teaching hospital tertiary referral centre.
Sample:
Thirty-two women over 65 years of age with a urodynamic diagnosis of genuine stress incontinence.
Results:
At one year, 22 women (79%) were subjectively cured or improved, and 14 (50%) were objectively cured; at two years, 18 (69%) and 14 (54%), respectively. Symptoms of urgency, urge incontinence, frequency and nocturia improved, while voiding difficulty remained unchanged. Brief urinary retention was encountered in seven women. No long term side effects or complications were encountered. Urodynamic studies suggest that collagen works by preventing premature bladder neck opening through physical stress, rather than by obstruction. This would account for the slight increase in functional urethral length.
Conclusions:
Contigen collagen is a simple and effective day case procedure as an alternative to major surgery and is without significant morbidity or complication. It is ideal for the elderly.