Glutaraldehyde Cross-Linked Collagen in the Treatment of Urinary Incontinence in Children

Abstract 

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 percent of patients, improvement by 54 percent and no change by 24 percent. There was statistically significant postoperative improvement of continence grade (exstrophy/epispadias p less than or equal to 0.004, spina bifida p less than or equal to 0.0001), decreased daily use of pads (exstrophy/epispadias p less than or equal to 0.008, spina bifida p less than or equal to 0.002) and dry interval (exstrophy/epispadias p less than or equal to 0.008, spina bifida p less than or equal to 0.004). Greater success occurred in cases of the exstrophy/epispadias complex (91 percent) than spina bifida (71 percent). No patient had unsafe bladder pressures as a result of collagen treatment. Reevaluation of a 1992 study group with an initial 88 percent cure or improvement rate showed that after a mean followup of 4.5 years the cure or improvement rate remained 86 percent.

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.