Glutaraldehyde cross-linked bovine collagen in exstrophy/epispadias complex.

We injected endoscopically 0.75 to 2.5 cc of cross-linked bovine collagen at the 3, 9 and 12 o'clock positions of the urethra or bladder neck of 9 children with epispadias and 7 with exstrophy. This procedure was performed in 10 children who were still incontinent after a Young-Dees operation. In 6 girls collagen was injected submucosally before bladder neck surgery to increase outlet resistance and to gain bladder capacity. A repeat injection was given to 3 patients after 1 year. Continence improved in 9 of the 10 cases injected after surgery of the bladder neck. Of the 6 children who underwent collagen treatment before reconstruction of the lower urinary tract capacity increased an average of 47% in 2 years in 5 and the procedure failed in 1. Submucosal injection of collagen is helpful in modulating outflow resistance and increasing bladder volume after primary closure of exstrophic bladders. Patients with small bladders following closure, who would otherwise be candidates for augmentation cystoplasty, may gain adequate bladder size with collagen injection.