Collagen Injection Therapy in Urinary Incontinence with ISD (Intrinsic Sphincter Deficiency)

Lee, Dong Soo; Lee, Jeong Gu

Abstract

Bovine collagen (Contigen(R), Bard Inc.) injection has been used for treating urinary incontinence caused by intrinsic sphincter deficiency (ISD) with relatively high success rate and fewer complication. Retrospective analysis was made for 11 urinary incontinent patients who have undergone collagen injection. Of the total, stress urinary incontinence (SUI) associated with ISD were noted in six, myelodysplasia in one, short bladder neck in one, cauda equina syndrome in one and, two with pelvic bone fracture. Average duration of symptoms was 10.8 years. Four patients had history of failed surgery to correct incontinence (two with Raz operations and two with plication of bladder neck). Transurethral injections of 4~12 ml of collagen were made at 4 and 8 o'clock position of the bladder neck with the bevelled portion of needle facing the urethral lumen. After the first injection, cure and improvement of incontinence were noted in 3 (SUI) and 6 (3 with SUI, 1 with short bladder neck, 1 with myelodysplasia and 1 with pelvic bone fracture) respectively. After the repeated injection for 3 patients who had improved after first injection, all became dry. At 13 months of follow-up, total success rate was 82% (5 with cure and S with improvement of the incontinence). Two patients who showed failure were all males with periurethral scar formation. Collagen injection seemed an effective therapeutic method in female SUI with ISD or myelodysplasia provided repeated injection is to be made However, it was suggested that the male patients or one with extensive scar formation were not good candidate for injection therapy.