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

Abstract

Purpose: 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. Materials and Methods: 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. Results: 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). Conclusions: 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.