Long-term results of transurethral collagen injection in men with intrinsic sphincter deficiency

Male stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) is a well-recognized potential complication of various forms of therapy for both benign and malignant conditions of the prostate. Short-term efficacy of collagen therapy for SUI in men has been demonstrated; however, little information exists on the long-term durability of this minimally invasive treatment modality. Herein, we present our longterm experience with transurethral collagen injection therapy in men with SUI. Sixty-eight men ages 45 to 75 years underwent collagen injection for treatment of urinary incontinence secondary to ISD. Incontinence resulted from radical prostatectomy (N = 47), external-beam radiation (8), cryotherapy (4), salvage radical prostatectomy (4), and transurethral resection of the prostate (TURF) (5). Response was judged according to changes in the number of pads used daily and the incontinence grade. The average amount of collagen injected was 36 cc (range 8-125 cc), and the average number of treatment sessions was 5 (range 3-15). With a mean follow-up of 38 (6-46) months, 10% of the patients were cured (no pads, Grade 0 incontinence), 10% were greatly improved (>50% decrease in pads used or improved incontinence grade), 67% had minimal to no improvement (<50% decrease in pads used or no change in continence grade), and 13% reported worsening of their incontinence. Patients with incontinence after TURF were most likely to achieve a favorable outcome, whereas patients with incontinence after salvage prostatectomy responded poorly. Complications were minimal and included hematuria (N = 10), transient urinary retention (8), and urinary tract infection (5). Collagen injection therapy is a safe, relatively noninvasive method of treatment for ISD in male patients. However, long-term success with collagen is disappointing in all groups with the exception of men with SUI after TURP.