Isom-Batz Ginger, Zimmern Philippe E
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
J Urol. 2009 Feb;181(2):701-4. doi: 10.1016/j.juro.2008.10.027. Epub 2008 Dec 16.
We evaluated the result of periurethral collagen injection in incontinent patients after prior urethral surgery.
We reviewed the charts of patients who underwent periurethral collagen injection between January 2000 and December 2006 for persistent stress urinary incontinence after a failed suspension procedure or urethral repair. Preoperative assessment included the validated Urogenital Distress Inventory-6 symptom questionnaire, a single global quality of life score, history and physical examination, cystogram while standing and multichannel urodynamics. All patients had a well supported urethra and intrinsic sphincteric deficiency. Outcome measures included questionnaires and 3-dimensional urethral ultrasound at 6 weeks, 6 to 12 months and yearly thereafter. In patients who were still symptomatic after the first injection a repeat injection was considered when there was asymmetrical or low collagen volume on ultrasound, and another therapy was considered when ultrasound findings were adequate.
In 31 consecutive patients Urogenital Distress Inventory-6 question 3 and quality of life scores decreased after collagen injection (mean volume 5.5 cc). Baseline postoperative collagen volume on ultrasound was 2.6 cc (range 0.8 of 4.8). Of the patients 93% considered themselves clinically improved or cured, 17 of 31 required only 1 injection with a symmetrical configuration in 83%, while 8 received 1 or 2 more injections because of an asymmetrical configuration (75%) and/or low volume. Despite a mean collagen volume of 3.2 cc (range 2 to 4.3) 6 women with persistent stress urinary incontinence underwent a pubovaginal sling procedure. Eight of 25 patients requiring only collagen had stable collagen volume for 2 years without repeat injection.
Collagen injection is a viable option with satisfactory results in this complex population.
我们评估了尿道周围胶原注射对既往接受过尿道手术的尿失禁患者的治疗效果。
我们回顾了2000年1月至2006年12月期间因悬吊带手术或尿道修复失败后持续性压力性尿失禁而接受尿道周围胶原注射的患者病历。术前评估包括经过验证的泌尿生殖系统困扰量表-6症状问卷、单一的总体生活质量评分、病史和体格检查、站立位膀胱造影以及多通道尿动力学检查。所有患者均存在尿道支撑良好但固有括约肌功能缺陷的情况。观察指标包括问卷调查以及在6周、6至12个月以及此后每年进行的三维尿道超声检查。首次注射后仍有症状的患者，若超声显示胶原分布不对称或体积较小，则考虑再次注射；若超声检查结果良好，则考虑采用其他治疗方法。
连续31例患者在接受胶原注射（平均注射量5.5 cc）后，泌尿生殖系统困扰量表-6的问题3得分及生活质量评分均有所下降。术后超声检查测得的胶原基线体积为2.6 cc（范围为0.8至4.8）。93%的患者认为自己在临床上有所改善或治愈，31例患者中有17例仅需注射1次，其中83%的注射形态对称，而8例因注射形态不对称（75%）和/或体积较小而接受了1次或2次以上的注射。尽管平均胶原注射量为3.2 cc（范围为2至4.3），仍有6例持续性压力性尿失禁女性接受了耻骨后阴道吊带术。25例仅需注射胶原的患者中有8例在2年内胶原体积稳定，无需再次注射。
对于这一复杂人群，胶原注射是一种可行的选择，且效果令人满意。
