Glutaraldehyde cross-lined collagen in the treatment of urinary incontinence in children

Purpose: Prospective analysis was done to assess the efficacy of glutaraldehyde cross-linked collagen in the treatment of pediatric structural urinary incontinence. Materials and Methods: A total of 40 pediatric patients (average age 12.1 years) with structural urinary incontinence received 70 glutaraldehyde cross-linked collagen injections. Of the 40 patients 25 had spina bifida, 12 had the exstrophy/epispadias complex, 2 had continent reservoirs and 1 had bilateral ureteral ectopia. Average followup was 2.1 years (range 3 months to 6.3 years), and included urodynamic evaluation and assessment of change in continence grade, daily pad use and dry interval. Patient satisfaction was evaluated by questionnaire concerning self-esteem, activity level and patient assessment of overall benefit. Results: Complete cure of incontinence was reported by 22% of patients, improvement by 54% and no change by 24%. There was statistically significant postoperative improvement of continence grade (exstrophy/epispadias p less than or equal to 0.004, spina bifida p less than or equal to 0.0001), decreased daily use of pads (exstrophy/epispadias p less than or equal to 0.008, spina bifida p less than or equal to 0.002) and dry interval (exstrophy/epispadias p less than or equal to 0.008, spina bifida p less than or equal to 0.004). Greater success occurred in cases of the exstrophy/epispadias complex (91%) than spina bifida (71%). No patient had unsafe bladder pressures as a result of collagen treatment. Reevaluation of a 1992 study group with an initial 88% cure or improvement rate showed that after a mean followup of 4.5 years the cure or improvement rate remained 86%. Conclusions: Collagen improves continence in the majority of children with anatomically based urinary incontinence. Exstrophy/epispadias patients have the best outcome from collagen treatment. Glutaraldehyde cross-linked collagen is durable in most patients who have an initially positive outcome.