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Paper Information

Title: 

PERIURETHRAL COLLAGEN INJECTION IN SEVERE URINARY INCONTINENCE AFTER BPH SURGERY

Type: PAPER
Author(s): GEAVLETE P.,SEYED AGHAMIRI -*,CAUNI V.,GEORGESCU D.,NITA GH.
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

INTRODUCTION AND OBJECTIVES: INCONTINENCE AFTER PROSTATIC SURGERY (RESECTION OR OPEN SURGERY) FOR BPH IS AN IMPORTANT COMPLICATION. TRANSURETHRAL INJECTION OF BOVINE DERMAL COLLAGEN SHOULD BE AN ALTERNATIVE TREATMENT AND DESPITE THE RECURRENCE RATE (CAUSED BY OF IT'S BIODEGRADABILITY) AFTER THIS MINIMALLY INVASIVE THERAPY, THE SIMPLICITY AND THE POSSIBILITY TO REPEATING THE MANEUVER COULD SUSTAIN THIS TECHNIQUE.
MATERIALS & METHODS: BETWEEN MARCH 1996 AND MARCH 2003 WE APPLIED GAX-AND ROMANIAN COLLAGE IMPLANTS VIA TRANSURETHRAL APPROACH IN 79 CASES WITH GRADE III INCONTINENCE MORE THEN 1 YEAR AFTER PROSTATIC SURGERY (31 AFTER TRANSURETHRAL RESECTION AND 44 AFTER OPEN SURGERY). THE URODYNAMIC STUDIES CERTIFIED THE DIAGNOSTIC AND URINE CULTURE WAS STERILE. DERMAL SKIN TEST WAS NEGATIVE IN ALL CASES. UNDER SPINAL (55 CASES) OR LOCAL (24 CASES) ANESTHESIA THE COLLAGEN WAS INJECTED SUPERIOR TO THE EXTERNAL SPHINCTER UNTIL COMPLETE (61 CASES) OR PARTIAL (18 CASES) URETHRAL LUMEN OBSTRUCTION WAS OBTAINED. SEVERAL NEEDLE POSITIONS ARE NEEDED IN ALL PATIENTS, THE STANDARD ENDOSCOPIC PROTOCOL BEING REPRESENTED BY INJECTION AT 3, 6 AND 9 O’CLOCK POSITIONS. IN 18 CASES WE DIDN’T OBTAIN A GOOD OCCLUSION OF THE URETHRAL LUMEN BECAUSE OF PREVIOUS THERAPY (ESPECIALLY AFTER TUR) WITH LIMITED SUBUROTHELIAL BULKING ASSOCIATED WITH RUPTURE OF THE UROTHELIUM. IN 64.55% OF CASES REINJECTION OF COLLAGEN WAS NECESSARY, TWICE IN 24 CASES AND THREE TIMES OR MORE IN 27 CASES. AVERAGE INJECTED VOLUME PER PATIENT WAS 31 ML.
RESULTS: AFTER FIRST INJECTION COMPLETE CONTINENCE WAS OBTAINED IN 43% OF CASES, 23% IMPROVED AND 34% WERE UNCHANGED. AFTER REPEATED INJECTION (AT THREE MONTHS INTERVAL) WE OBTAINED AN INCREASE OF CASES WITH PERFECT CONTINENCE AT 58% OF CASES. AFTER A MEAN PERIOD OF 18 MONTHS THE COMPLETE CONTINENCE REMAINED ONLY IN 31% OF THE PATIENTS. SO IT WAS NECESSARY TO REPEAT THE COLLAGEN INJECTION TWICE, THREE OR MORE TIMES. AFTER A MEAN 33 MONTHS FOLLOW-UP PERIOD OUR PATIENTS WERE: 39% WITH COMPLETE CONTINENCE, 17% IMPROVED AND 44% UNCHANGED. PERIOPERATIVE COMPLICATIONS WERE REPRESENTED BY: URINARY RETENTION (24%), IRRITATIVE VOIDING SYMPTOMS (17%), URINARY TRACT INFECTION (4%), HEMATURIA (2%), PAIN AT INJECTION SITE (1%), URETHRITIS (1%) CONCLUSIONS: PERIURETHRAL INJECTIONS OFFER A GOOD ALTERNATIVE TREATMENT FOR THE SEVERE URINARY INCONTINENCE AFTER BPH SURGERY. GAX-COLLAGEN IS THE MOST WIDELY USED INJECTABLE TREATMENT, BECAUSE IT HAS BEEN SHOWN TO BE BIOCOMPATIBLE AND BIODEGRADABLE. DESPITE THE HIGH REINJECTION RATES, THE LONG TIME EFFICACIOUSNESS IN 50% OF PATIENTS, THE USE OF COLLAGEN REMAINS AN EFFECTIVE PROCEDURE.

 
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