Collagen Injection for Female Urinary Incontinence After Urethral or Periurethral Surgery

Purpose

We evaluated the result of periurethral collagen injection in incontinent patients after prior urethral surgery.

Materials and Methods

We reviewed the charts of patients who underwent periurethral collagen injection between January 2000 and December 2006 for persistent stress urinary incontinence after a failed suspension procedure or urethral repair. Preoperative assessment included the validated Urogenital Distress Inventory-6 symptom questionnaire, a single global quality of life score, history and physical examination, cystogram while standing and multichannel urodynamics. All patients had a well supported urethra and intrinsic sphincteric deficiency. Outcome measures included questionnaires and 3-dimensional urethral ultrasound at 6 weeks, 6 to 12 months and yearly thereafter. In patients who were still symptomatic after the first injection a repeat injection was considered when there was asymmetrical or low collagen volume on ultrasound, and another therapy was considered when ultrasound findings were adequate.

Results

In 31 consecutive patients Urogenital Distress Inventory-6 question 3 and quality of life scores decreased after collagen injection (mean volume 5.5 cc). Baseline postoperative collagen volume on ultrasound was 2.6 cc (range 0.8 of 4.8). Of the patients 93% considered themselves clinically improved or cured, 17 of 31 required only 1 injection with a symmetrical configuration in 83%, while 8 received 1 or 2 more injections because of an asymmetrical configuration (75%) and/or low volume. Despite a mean collagen volume of 3.2 cc (range 2 to 4.3) 6 women with persistent stress urinary incontinence underwent a pubovaginal sling procedure. Eight of 25 patients requiring only collagen had stable collagen volume for 2 years without repeat injection.

Conclusions

Collagen injection is a viable option with satisfactory results in this complex population.

Key Words: urethra, urinary incontinence, stress, female, collagen, injections

Abbreviations and Acronyms: 3-D, 3-dimensional, ISD, intrinsic sphincter deficiency, PCI, periurethral collagen injection, QOL, quality of life, SUI, stress urinary incontinence, TOT, transobturator tape, VLPP, Valsalva leak point pressure