Collagen injection therapy for urinary incontinence.

The goal of treatment in patients with ISD is to allow for coaptation of the urethral mucosa without obstruction. Urodynamically this means that the pressure necessary to open the urethra (leak point pressure) is increased but no appreciable change occurs in the closure pressure of the urethra. Periurethral injections have the potential to accomplish this need. Contigen appears efficacious and safe in the properly chosen patient. The cross-linking of the bovine collagen has enhanced the durability of the substance when injected and reduced the potential to produce local immune-type reactions. None of the patients in the multicenter trial (many of whom have been followed for more than 5 years) have had an adverse event related to immunogenicity. The technical aspects of the actual injection process are easily learned, and no special equipment is needed. More important than technique is patient selection. The best results are attained in those patients who do not have detrusor problems, have an adequate bladder capacity, and have minimal anatomic abnormality (urethral hypermobility). Because injection of Contigen can usually be done with local anesthesia alone, a significant number of patients who are not acceptable candidates for open surgical procedures (slings and artificial sphincters) may benefit from this treatment. It is anticipated that Contigen will be a valuable adjunct in the management of both adult and pediatric incontinence problems.