Early experience with intraurethral collagen injections for urinary incontinence.

We report on 41 patients (10 men and 31 women) who underwent collagen injections for urethral incompetence. Mean followup was 6 months (range 3 to 11 months) in men cured or improved, 8.4 months (range 3 to 15 months) in women who were cured and 4.5 months (range 2 to 10 months) in women who were improved. In women the procedure was usually performed through a periurethral approach while they were under local anesthesia and in men it was performed transurethrally while under either general or local anesthesia. Of the 31 women 28 (90.3%) were cured (15) or improved (13). Mean maximum Valsalva pressure increased from 31 cm. water before injection to 85 cm. water at 6 months after injection in women who were cured or improved. The mean amount of collagen used in the female group was 12.7 cc (range 2.5 to 47.5) and the mean number of treatments was 2 (range 1 to 7). Of the men 7 (70%) had successful results (2 cured and 5 improved). In contrast to the women, they required a mean of 51.8 cc (range 7.5 to 82.5) of collagen and a mean of 6 treatments (range 3 to 12). Of 5 patients with bladder instability 4 did not improve. One patient suffered acute bacterial prostatitis and 2 patients had post-injection urinary retention. All women with little or no bladder neck hypermobility (types 1 and 3) were either cured or improved. We conclude that intraurethral collagen injection is safe and simple to perform. The results achieved in women are acceptable. In men, while collagen does provide improvement, the cost-to-benefit ratio and effectiveness are less than those in women. Instability may obviate a good outcome.