Appell R A
Department of Urology, Cleveland Clinic Foundation, Ohio.
Urol Clin North Am. 1994 Feb;21(1):177-82.
The goal of treatment in patients with ISD is to allow for coaptation of the urethral mucosa without obstruction. Urodynamically this means that the pressure necessary to open the urethra (leak point pressure) is increased but no appreciable change occurs in the closure pressure of the urethra. Periurethral injections have the potential to accomplish this need. Contigen appears efficacious and safe in the properly chosen patient. The cross-linking of the bovine collagen has enhanced the durability of the substance when injected and reduced the potential to produce local immune-type reactions. None of the patients in the multicenter trial (many of whom have been followed for more than 5 years) have had an adverse event related to immunogenicity. The technical aspects of the actual injection process are easily learned, and no special equipment is needed. More important than technique is patient selection. The best results are attained in those patients who do not have detrusor problems, have an adequate bladder capacity, and have minimal anatomic abnormality (urethral hypermobility). Because injection of Contigen can usually be done with local anesthesia alone, a significant number of patients who are not acceptable candidates for open surgical procedures (slings and artificial sphincters) may benefit from this treatment. It is anticipated that Contigen will be a valuable adjunct in the management of both adult and pediatric incontinence problems.
内在括约肌缺陷（ISD）患者的治疗目标是实现尿道黏膜贴合且无梗阻。从尿动力学角度来看，这意味着打开尿道所需的压力（漏点压力）增加，但尿道闭合压力无明显变化。尿道周围注射有可能满足这一需求。在选择合适的患者中，Contigen（一种药物）似乎有效且安全。注射时，牛胶原蛋白的交联增强了该物质的持久性，并降低了产生局部免疫反应的可能性。多中心试验中的患者（其中许多人已被随访超过5年）均未出现与免疫原性相关的不良事件。实际注射过程的技术层面很容易掌握，且无需特殊设备。比技术更重要的是患者选择。在那些没有逼尿肌问题、膀胱容量足够且解剖学异常（尿道活动过度）最小的患者中可获得最佳效果。由于通常仅用局部麻醉就能进行Contigen注射，许多不适合开放式手术（吊带和人工括约肌）的患者可能会从这种治疗中受益。预计Contigen将成为成人和儿童尿失禁问题管理中的一种有价值的辅助手段。
