Transurethral collagen injection for female stress incontinence

Periurethral collagen injections have been used to treat female urinary incontinence secondary to intrinsic sphincteric deficiency (ISD). As an alternative, a transurethral submucosal collagen injection was used in 33 consecutive women suffering from stress incontinence secondary to ISD at Tulane University Medical Center. Prior to the procedure, careful clinical examination with a videofluorourodynamic study was performed for each case. The procedure was carried out under local anesthesia assisted with monitored anesthesia care (MAC). The collagen was injected transurethrally by the long collagen needle (C. R. Bard). In the first 11 cases the average cumulative collagen injected per patient was 6.1 ml, whereas in the last 22 cases the average was 3.5 ml. As a result of the injection 16 patients were dry (48.5%) and 11 were improved (33.3%), with an overall success rate of 81.8%. The injection failed in 6 patients (18.1%). The mean follow-up was 18.8 months, with a range of 2-33 months. In the successful group there was a significant decrease in pretreatment frequency, from an average of 8 to 4.9 (P = 0.005) and in nocturia from an average of 2.14 to 0.76 (P = 0.001). Also, there was a significant decrease in the number of pads, from an average of 3.7 to 1.1 (P = 0.001). The stress leak-point pressure showed a significant increase, from an average of 68.1 to 93.5 cm H2O (P = 0.03). There was no relation between grade of incontinence and the success of the injection. Two cases suffered from temporary urinary retention. This study revealed that the transurethral submucosal collagen injection is an effective method for treating cases of intrinsic sphincteric deficiency. The volume of collagen required to produce the seal effect is small and it may decrease the reinjection rate. As experience is gained, the procedure time is typically 15 minutes. This makes it a reliable, cost-effective and well-controlled method. However, it has a learning curve and the cystoscope instruments require minor adaptation for its use.