Collagen Injections Temporary Fix for Incontinence.

VAIL, COLO. -- Transurethral collagen injections are a valuable therapeutic option in selected women with stress urinary incontinence, Dr. Nicollete S. Horbach said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

This minimally invasive treatment for incontinence is indicated in women with a poorly functioning urethra but normal anatomic support. These are patients who either have undergone a prior surgical repair that corrected their anatomic defect but left them incontinent due to their intrinsic sphincter deficiency, or women who have simply lost sphincter tone as they have aged, explained Dr. Horbach, immediate past president of the American Urogynecologic Society.

Candidates for collagen injections are identified by preprocedural testing demonstrating either a lower urethral closure pressure of less than 20 cm [H.sub.2]O or a leak point pressure below 60 cm [H.sub.2]O. Medicare will now reimburse for the injections only if these criteria are met.

Dr. Horbach occasionally employs collagen injections in patients who don't meet these criteria. For example, she has one patient who is an avid marathon runner. This woman doesn't have severe intrinsic sphincter deficiency, but she experienced urinary incontinence during her long races and training runs. Dr. Horbach treated her with collagen injections, and for the time being her patient no longer loses urine on her very long runs.

The material of choice for the injections is bovine glutaraldehyde cross-linked collagen, manufactured by Contigen, he said. Skin testing is required before treatment to exclude the 3% of women who are allergic to bovine collagen.

The injections are designed to improve urethral coaptation by bulking up the submucosal tissue. The goal is to place the collagen in such a way that it narrows the ...