Richardson T D, Kennelly M J, Faerber G J
University of Michigan Medical Center, Department of Surgery, Ann Arbor, USA.
Urology. 1995 Sep;46(3):378-81. doi: 10.1016/S0090-4295(99)80223-4.
To determine the clinical efficacy, safety, and durability of endoscopically injected glutaraldehyde cross-linked (GAX) collagen for the treatment of intrinsic sphincter deficiency (ISD) in women.
Forty-two women with a mean age of 64 years (range, 28 to 88) underwent injection of GAX collagen for ISD. Collagen was injected via a transurethral or periurethral approach. Treatment outcome was based on the change in stress leak point pressures (SLPP) and individual incontinence grades before and after collagen injection.
With a mean follow-up of 46 months (range, 10 to 66), 83% were cured (n = 17), greatly improved (n = 5), or improved (n = 13), and 17% were unchanged (n = 3) or worse (n = 4). The median number of treatments was 2 (range, 1 to 8). The 22 women greatly improved or cured required a mean of 2.4 collagen injection treatments, whereas the 20 women who were improved, unchanged, or worse had a mean of 4.1 treatments (P = 0.009). The mean amount of collagen injected per patient was 28.3 cc (range, 2.5 to 85). The group of women who were greatly improved or cured had a mean of 17.5 cc of collagen injected, whereas those who were improved, unchanged, or worse had a mean of 39.5 cc injected (P = 0.002). Mean pretreatment SLPPs of women improved, greatly improved, or cured versus the women unchanged or worse were not significantly different (P = 0.015). The 35 women who were improved or cured had a significant increase in mean SLPP of 65.4 cm H2O (P = 0.001) compared to a mean change in SLPP of 14.7 cm H2O in those women who were unchanged or worse (P = 0.038).
GAX collagen injection for the treatment of stress urinary incontinence secondary to ISD appears to be safe, effective, and durable; hence, it should be considered the treatment of choice in appropriately selected female patients.
确定经内镜注射戊二醛交联（GAX）胶原蛋白治疗女性固有括约肌缺陷（ISD）的临床疗效、安全性及持久性。
42名平均年龄64岁（范围28至88岁）的女性接受了GAX胶原蛋白注射治疗ISD。胶原蛋白通过经尿道或尿道周围途径注射。治疗结果基于注射胶原蛋白前后压力性漏尿点压力（SLPP）的变化及个体尿失禁分级。
平均随访46个月（范围10至66个月），83%的患者治愈（n = 17）、显著改善（n = 5）或改善（n = 13），17%的患者无变化（n = 3）或病情恶化（n = 4）。治疗次数中位数为2次（范围1至8次）。22名显著改善或治愈的女性平均需要2.4次胶原蛋白注射治疗，而20名改善、无变化或病情恶化的女性平均需要4.1次治疗（P = 0.009）。每位患者注射的胶原蛋白平均量为28.3 cc（范围2.5至85 cc）。显著改善或治愈的女性组平均注射17.5 cc胶原蛋白，而改善、无变化或病情恶化的女性组平均注射39.5 cc（P = 0.002）。改善、显著改善或治愈的女性与无变化或病情恶化的女性治疗前平均SLPP无显著差异（P = 0.015）。与无变化或病情恶化的女性SLPP平均变化14.7 cm H2O相比，35名改善或治愈的女性平均SLPP显著增加65.4 cm H2O（P = 0.001）（P = 0.038）。
注射GAX胶原蛋白治疗ISD继发的压力性尿失禁似乎安全、有效且持久；因此，在适当选择的女性患者中应将其视为首选治疗方法。
