GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up

Abstract

Objective To determine the efficacy of GAX collagen in the treatment of elderly women with genuine Design A single centre prospective study.Setting A London teaching hospital.Participants Thirty-four women older than 60 years of age with genuine stress incontinence diagnosed Interventions Up to three paraurethral injections of GAX collagen. Main outcome measuresstress incontinence. on videocystourethrography.Subjective and pad test assessments performed pre-operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre-operatively, after three months and one year.Results There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre-treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size.Conclusion GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.

Urethral injection therapy: What is the mechanism of action?

“…The resting opening pressure was unchanged after the bulking procedure in this study which is in agreement with previous study where the resting maximum urethral closing pressure (MUCP) was unchanged after injection with polyacrylamide hydrogel 8 or collagen. 12,13 The opening pressure during squeezing, on the other hand, was significantly increased after the injection therapy. The increased squeezing opening pressure might be responsible for the symptom improvement reported by the patient which is supported by the fact that only the patients with symptom improvement had increased squeezing opening pressure.…”

Laparoscopic Burch colposuspension after failed sub-urethral tape procedures: a retrospective audit

“…Patients with recurrent stress urinary incontinence who are compromised by medical conditions, age or personal concerns may benefit from the injection of a peri-urethral bulking agent. Cure or improvement rates are reported to be approximately 40-60% [20,21] in case of recurrent stress urinary incontinence, which is lower than a repeat colposuspension or sling procedure. Safety and low impact of these procedures are characteristics favourable for those desiring less invasive surgery.…”

Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy

“…De novo urge incontinence can also occur-a prevalence of 13% was quoted for collagen-but it is generally shortlived [28,29]. Overall, urethral injection has not been associated with de novo detrusor overactivity [21], but in one study, 39% of patients developed symptoms after the first injection of collagen, possibly related to the elderly age of the population (mean age, 76 years) [30]. A further potential postinjection complication is the development of an injection site mass (cyst, sterile abscess).…”