Long-term efficacy of periurethral collagen injection for the treatment of urinary incontinence secondary to myelomeningocele.

Abstract

The reports of efficacy of periurethral collagen injection (Contigen, Bard, Covington, Georgia) for treatment of urinary incontinence in the myelomeningocele population are limited and variable. We reviewed the efficacy of periurethral collagen in patients with myelomeningocele to provide long-term followup data. From 1994 to 1999, 19 children and 6 adults with myelomeningocele underwent periurethral injections of collagen with an average of 2 treatments per patient. Mean followup +/- SD from last injection in the pediatric and adult groups was 2.9 +/- 1.5 years and 4.7 +/- 2.6 years, respectively. Postoperative continence was defined as dry, improved or unchanged. No pediatric patients became dry, 7 (37%) improved and 12 (63%) were unchanged. A single adult was dry (17%), 4 (67%) improved and 1 remained unchanged. Transient improvement was noted in 8 of the 13 patients who reverted to an unchanged status. Response rate was 66% in nonambulatory patients versus 42% in ambulatory patients (p = 0.38). Of 12 patients who responded and 13 who did not 8 in each group required 2 or more treatments. The responding group percentage of predicted bladder capacity was 97.6% versus 89.5% in those who remained unchanged (p = 0.66). The initial transient improvement following collagen injection and the long-term improvement following repeat injections suggest that degradation of collagen decreased its efficacy. The long-term results of this minimally invasive technique are poor.