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MINERVA UROLOGICA E NEFROLOGICA
A Journal on Nephrology and Urology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Minerva Urologica e Nefrologica 1998 September;50(3):213-21
Urethral collagen injection in the treatment of urinary incontinence. Comparison between transurethral and periurethral approach
Von Heland M. 1, Mantovani F. 2, Zanetti G. 2, Ceresoli A. 2, Ginepri A. 1, Frascaro E. 1, Pisani E. 2, Di Silverio F. 1
1 Università degli Studi di Roma, «La Sapienza» - Roma, Dipartimento di Urologia «U. Bracci»;
2 Università degli Studi - Milano, Istituto di Urologia, IRCCS
Background. In mini-invasive surgery for the treatment of urinary incontinence injectable substances such as politef, autologous fat or bovin collagen, which can increase urethral resistance or support the sphinteric one are particularly used. It’s a simple procedure in which patients may undergo local anesthesia, in short time and in “day hospital” regimen. Collagen, used as an injectable bulking agent, is the gold standard for this surgical tecnique because of complete biocompatibility, no evidences of adverse immunogenic effects,foreign-body reaction, migration of injected material, and because of higher fluidity which allows the use of thin needles compared to Politef (politetrafluoroethilene) where an injection device is requested. Bovin collagen is partially reabsorbed within 24-36 months and a reinjection is often necessary. Although autologous fat is cheeper than bovin collagen, its injection shows more difficulties due to the need of higher needle diameter and time to store and prepare the material to inject.
Methods. The results obtained by two different approaches: transuretrhal injection of collagen and periurethral injection of collagen have been studied. A total of 48 patients underwent collagen injection for treatment of urinary incontinence: 24 treated by trans-urethral approach and 24 by periurethral approach. Follow-up at 6, 12, 24 months after treatment includes: objective exam, PAD test, functional evaluation, complete urodynamic evaluation (uroflow, cystomanometry, LPP, pressure/flow study, UPP).
Results. No clinical differences between peri/trans-urethral approach were found although collagen injection via transurethral technique need fewer material, reducing cost of treatment: an efficacy of treatment in 80% of patients and restoration of a complete urinary continence in 50% of patients was obtained. Although no clinical differences were demonstrated between the two different sites of injection, transurethral approach can be used similarly in both sexes even if without a modified resector as “injection device” it’s more difficult to inject collagen in the right position , at the level of bladder neck submucosa. Perineal approach, exlusive of female sex, realizes the procedure without bleeding of urethral mucosa and no waste of collagen, though a longer period of training by surgeon is requested. After four years of experience the authors agreed that with an adequate injection device (modified resector), transurethral approach should be preferred, thus depending on the posibility to inject collagen in a correct position, just under bladder neck mucosa, which is possible to manage with this technique, in order to reduce reabsorption process of collagen and to obtain a longer efficacy of treatment reducing the number of reinjection and of course the cost of treatment. Collagen injection should be considered within an integrated therapeutical picture together with topic and systemic pharmacotherapy, physiotherapy, not excluding surgery techniques such as implantation of an artificial sphincter device in man or a sling procedure in woman.