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Purpose
We studied patient selection parameters and durability of response of collagen injections for female stress incontinence.Materials and Methods
A total of 187 women 15 to 87 years old (mean age 63) underwent collagen injections for urethral incompetence. Treatment outcome was determined by a change in individual incontinence grades before and after injection.Results
Of the 187 women 43 (23 percent) were cured and 97 (52 percent) improved, while injection failed in 47 (25 percent). Mean followup in the successful (cured or improved) group was 22 months (range 4 to 69) after the last collagen injection. No difference in outcome was noted in relation to patient age or pretreatment grade of incontinence. Of the 31 patients with bladder instability 13 (42 percent) had a favorable outcome. No significant difference in outcome was noted in patients with or without hypermobility (p = 0.21235). Patients with type 3 incontinence required the largest amount of collagen for a successful outcome. Persistence of continence in 80 patients who were cured for at least 2 months was plotted on a Kaplan-Meier survival curve. The probability of remaining dry without additional collagen was 71, 58 and 46 percent at 1 to 3 years, respectively.Conclusions
Intraurethral collagen is a safe and well tolerated procedure. Pretreatment bladder instability may be an adverse factor. Patients with or without hypermobility had equal benefit. Long-term durability was noted. If deterioration occurred, repeat collagen injections restored success. 相似文献2.
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Endoscopic Injection of Collagen for the Treatment of Female Urinary Stress Incontinence 总被引:1,自引:0,他引:1
Leonard Pek Kiang Ang Kah Phuan Tay Peter Huat Chye Lim Hong Chee Chng 《International journal of urology》1997,4(3):254-258
Background The objective of our study was to assess the efficacy and safety of glutaraldehyde cross-linked collagen injection in the treatment of female urinary stress incontinence.
Methods We conducted a retrospective analysis of the records of 105 women who underwent collagen injection for urinary stress incontinence between March 1991 and April 1995. Preoperative assessment included uroflowmetry, residual urine determination, and urodynamic studies.
Results Of the 105 women in our series, 95 patients (90.5%) had initial successful results at 3 months (61.0% cured, 29.5% significantly improved) while 4 patients (3.8%) had slight improvement and 6 (5.7%) failed surgical correction. One year after the procedure, the success rate dropped to 81.9% (86 patients) with 46.7% cured and 35.2% significantly improved. Nine patients (8.6%) had slight improvement and 10 patients (9.5%) failed surgical correction. Eight patients (7.6%) with initial unsatisfactory results underwent additional sessions of collagen injection and were subsequently either cured or had significant improvement. Twenty-three patients (21.9%) suffered a relapse. The mean time to relapse was 13.3 months, and 6 of those who relapsed underwent repeated injections with favorable results. Complications were minimal; 6 patients had temporary retention of urine, and 2 patients had urinary tract infections.
Conclusions We conclude that glutaraldehyde cross-linked collagen injection is a simple and safe method of treatment for urinary stress incontinence. A longer follow-up period is necessary to assess the long-term efficacy of this treatment. 相似文献
Methods We conducted a retrospective analysis of the records of 105 women who underwent collagen injection for urinary stress incontinence between March 1991 and April 1995. Preoperative assessment included uroflowmetry, residual urine determination, and urodynamic studies.
Results Of the 105 women in our series, 95 patients (90.5%) had initial successful results at 3 months (61.0% cured, 29.5% significantly improved) while 4 patients (3.8%) had slight improvement and 6 (5.7%) failed surgical correction. One year after the procedure, the success rate dropped to 81.9% (86 patients) with 46.7% cured and 35.2% significantly improved. Nine patients (8.6%) had slight improvement and 10 patients (9.5%) failed surgical correction. Eight patients (7.6%) with initial unsatisfactory results underwent additional sessions of collagen injection and were subsequently either cured or had significant improvement. Twenty-three patients (21.9%) suffered a relapse. The mean time to relapse was 13.3 months, and 6 of those who relapsed underwent repeated injections with favorable results. Complications were minimal; 6 patients had temporary retention of urine, and 2 patients had urinary tract infections.
Conclusions We conclude that glutaraldehyde cross-linked collagen injection is a simple and safe method of treatment for urinary stress incontinence. A longer follow-up period is necessary to assess the long-term efficacy of this treatment. 相似文献
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Carl G. Klutke Robert B. Nadler Debbie Tiemann Gerald L. Andriole 《The Journal of urology》1996,156(5):1703-1706
Purpose
Results of retrograde transurethral collagen injection for treatment of stress urinary incontinence have been generally disappointing for men with intrinsic sphinchter deficiency following radical prostatectomy. We described a new technique of antegrade transvesical collagen injection using suprapublic percutaneous bladder access.Materials and Methods
Between October 1994 and January 1996, 20 patients underwent antegrade collagen injection for post-radical prostatectomy stress urinary incontinence. Evaluation by pad test, urodynamics and subjective scores was performed before and after injections.Results
At a mean followup of 8.5 months 9 of 20 patients (45 percent) had significant subjective improvement and 5 (25 percent) were totally dry.Conclusions
Antegrade collagen injection is a promising and simple method of correcting post-radical prostatectomy stress urinary incontinence. Further study and longer followup are necessary to determine its precise role in the treatment of this condition. 相似文献6.
Purpose
We assessed the long-term results of the Marshall-Marchetti-Krantz procedure.Materials and Methods
A total of 151 case records was reviewed and a questionnaire was mailed to patients to estimate the success rate and patient satisfaction.Results
The response rate was 67.3 percent (101 replies). The overall success rate was 72.8 percent (mean followup 51.5 months). The success rates in patients with irritative symptoms and pure stress incontinence were 65 percent and 82.6 percent, respectively. The procedure was equally effective for recurrent stress incontinence.Conclusions
The procedure is characterized by a high success rate 5 years postoperatively. The method of review, based on a mailed questionnaire, appears to be more objective than conventional reviews but further improvements may increase the accuracy. 相似文献7.
Persistence of Delayed Hypersensitivity following Transurethral Collagen Injection for Recurrent Urinary Stress Incontinence 总被引:2,自引:0,他引:2
K. T. Echols R. R. Chesson E. F. Breaux S. A. Shobeiri 《International urogynecology journal》2002,13(1):52-54
Transurethral collagen injection is both safe and effective when used for the treatment of genuine stress urinary incontinence.
It is associated with a minimal inflammatory response, and virtually no foreign body reaction. Most allergic reactions occur
within 72 hours of treatment (immediate hypersensitivity). Although uncommon, delayed hypersensitivity reactions may occur
and it is advisable to administer a collagen skin test 30 days prior to the procedure. Adverse effects may cause long-term
sequelae, such as severe trigonal tenderness, urgency, frequency, hematuria, urinary retention and persistent stress urinary
incontinence. A case of a prolonged delayed hypersensitivity reaction following negative collagen skin testing after transurethral
collagen injection is presented. Treatment of stress incontinence could not be initiated until symptoms decreased significantly
after 1 year. 相似文献
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We retrospectively identified 37 cases in which urinary incontinence occurred at rest during urodynamic testing in the absence
of a coincident detrusor contraction or urethral relaxation. This phenomenon, genuine stress incontinence at rest, was observed
during 9.6% of multichannel cystometrograms performed at our institution. The observed urine loss occurred at bladder volumes
between 145 ml and 800 ml. Loss occurred with bladder overdistension (overflow incontinence) in only 3 subjects (8%). Decreased
bladder compliance was observed in 11 (30%) and decreased outlet resistance was demonstrated in 24 (65%). Our findings suggest
that genuine stress incontinence at rest is relatively common in a referred population of incontinent women. This phenomenon
is associated with impaired urethral function and/or decreased bladder compliance. 相似文献
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The glycogenolysis markers (glycogen content, active and total glycogen phosphorylase [EC 2.4.1.1.] activities, and active
and total acid exo-alpha-1,4-glucosidase [EC 3.2.1.3.] activities) in the urinary bladder muscle from two patients with stress
urinary incontinence and concomitant detrusor instability were studied. Glycogen depletion and activation of glycogen phosphorylase
were found. 相似文献
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