JOURNAL OF FEMALE
Purpose: We determine the clinical efficacy of endoscopically injected collagen for the treatment of new onset urinary incontinence in women following cystectomy and orthotopic neobladder.
Materials and Methods: Three women 58 to 74 years old underwent transurethral collagen injection for stress urinary incoritinence following cystectomy and orthotopic neobladder. Before cystectomy 2 women denied having any stress urinary incontinence while 1 oomplained of mild incontinence. Onset of incontinence following cystectomy and neobladder formation ranged from 8 months to 3 years, and average pad use ranged from 3 to 5 per 24-hour period. A11 patients underwent video urodynamic evaluation before collagen injection. Neobladder capacity was 180 to 400 cc and Valsalva leak point pressures ranged from 30 to 60 cm. water.
Results: A total of 6 injections were given, including 3 injections in 1 patient, 2 in 1 and 1 in 1. All 3 women had significant improvement or became dry with initial injection but required repeat injections to maintain improved continence status. At 7 to 8 months after the last injection 1 woman was dry, 1 used 1 or no pad daily and 1 reported no durable change in stress urinary incontinence.
Conclusions: Collagen injection appears to be a successful, minimally invasive treatment for new onset stress urinary incontinence following oystectomy and orthotopic neobladder in women.
EDITORIAL COMMENTIn the nineties we saw the development of cystectomies with preservation of the urethra and the realization of orthotopic neobladders in women, questioning one more "scientific truth" of the impossibility of maintaining continence in the women. Several series have shown diurnal continence in 70 to 90% of the cases. Another peculiar aspect of orthotopic neobladders in the woman is the development of hypercontinence with a larger incidence of autocatheterization1. One of the explanations for this fact would be the development of "neovesicocele" or maintenance of the bladder neck. Other studies have tried to evaluate the effectiveness of collagen in the treatment of Urinary Incontinence in patients with bladder and etiology that that alternated from extrophy to stress Urinary Incontinence. The results showed that they achieved Urinary continence in more than 50% of the cases, and these, to the urodynamic study showed increase of pressure to stress loss. Another evidence was that most patients that did not benefit from the treatment possessed or vesicle instability or low complacency. Another curious fact is that the results of Urinary Incontinence treatment with endoscopic injection apparently is better in women than in men. Appell et al2 (1992) related Urinary Incontinence, with more than a year of follow-up, in 66.7% in men and 92.6% in women. Although this article shows not a significant casuistic, it is the time for orthotopic with sphincterian urinary incontinence. This conduct still shows the possibility of reapplication, with low morbidity and the use of local anesthesia.
Josť Carlos Souza Trindade Filho
1- Stenzi A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G. Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol, 1995;154:2044-9.
2- Appel RA, Macaluso JN, Deutch JS, Goodman JR, Prats LJ, Wahl P. Endourologic control of incontinence with gax collagen: the isu experience. J Endourol, 1992; 6: 275-7.
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