Proper patient selection for Contigen Bard Collagen implant.

Stress incontinence affects primarily women, and a common cause is intrinsic sphincter deficiency (ISD). Traditionally, patients with ISD are treated surgically with implantation of an artificial sphincter or with a pubovaginal sling procedure. Although these procedures are effective, an alternate nonsurgical treatment option is Contigen Bard Collagen Implant. Ensuring optimal results with Contigen Implant requires proper diagnosis and patient selection. Contigen Implant is indicated for the treatment of urinary incontinence from ISD. Candidates are usually females with at least one previous failed suspension and with an open bladder neck at rest. Patients with a hypermobile urethra, high leak point pressures, or significant detrusor problems are poor candidates for Contigen. Those who are considered for Contigen should undergo a diagnostic evaluation to confirm the presence of incontinence, identify contributing factors, and identify the need for further diagnostic evaluation. The basic evaluation can be performed by any physician. It consists of a thorough history, physical examination, and urinalysis. It may also include a patient diary of voiding activity and a pad test to quantify the degree of incontinence. Those patients in whom incontinence is confirmed with a basic evaluation should undergo urodynamic evaluation by an experienced urologist. The object is to identify the specific cause of incontinence, detect functional, neurological, or anatomic lesions, and help select the most appropriate therapy. The urodynamic evaluation consists of cystometry, uroflowmetry, cystogram with voiding cystourethrogram, determination of leak point pressure and post-void residual, and videourodynamic studies if indicated. Optimal outcomes with Contigen Implant will be realized through proper patient selection, and this requires a thorough patient evaluation.