Rivas D A, Chancellor M B, Hanau C, Bagley D H, Goldberg B
Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
J Endourol. 1996 Feb;10(1):61-6. doi: 10.1089/end.1996.10.61.
To determine the acute and chronic ultrasonographic and histologic characteristics of injected glutaraldehyde cross-linked collagen in an animal model in order to enhance the therapeutic efficacy of the delivery of collagen for the treatment of urinary incontinence, three different depths of endoluminal ultrasound-guided injection (submucosal, intramuscular, periadventitial) of collagen into the urethral and bladder walls in two Yucatan mini pigs were investigated. The ultrasonographic characteristics of the injected material were examined 1, 4, 8, and 12 weeks later. A separate set of collagen injections, into the dermis and intramuscular layer of the lateral thigh of the animals, was undertaken with small-parts ultrasound guidance and follow-up. The injected tissues of the bladder, urethra, and thigh were ultrasonographically and histologically examined 3 months post-injection. Acutely injected collagen appeared hypoechoic on ultrasonography, although echogenicity increased over time. Submucosally injected collagen remained contained, forming a discrete collection of the material, whereas periadventitially injected collagen dispersed immediately. The ultrasonographic appearance and size of collagen collections correlated directly with their histologic identification and measurement. Injected collagen generated little inflammatory reaction, although infiltration by histiofibroblasts and neovascularization of the injected collagen occurred. Submucosal collagen injection resulted in superior longevity compared with intramuscular injection. From the results of our study, we hypothesize that durable success with collagen injection for the treatment of urinary incontinence is attributable to histiofibroblast infiltration of the injected collagen. When injected collagen is replaced with a hypertrophic scar, long-lasting clinical success is likely. If the injected collagen is replaced with a contracted scar, however, urethral coaptation may not persist. Endoluminal ultrasonography is helpful in ensuring the accurate submucosal location of collagen injection and in avoiding dispersion of the material and should enhance therapeutic efficacy in the treatment of urinary incontinence.
为了提高胶原蛋白注射治疗尿失禁的疗效，在动物模型中确定注射戊二醛交联胶原蛋白的急性和慢性超声及组织学特征，研究了两只尤卡坦小型猪尿道和膀胱壁内三种不同深度（黏膜下、肌层内、外膜周围）的腔内超声引导胶原蛋白注射。在注射后1、4、8和12周检查注射材料的超声特征。在小动物超声引导下并进行随访，在动物大腿外侧的真皮和肌层内进行另一组胶原蛋白注射。在注射后3个月对膀胱、尿道和大腿的注射组织进行超声和组织学检查。急性注射的胶原蛋白在超声检查中呈低回声，尽管随着时间推移回声增强。黏膜下注射的胶原蛋白保持聚集状态，形成离散的物质团块，而外膜周围注射的胶原蛋白立即分散。胶原蛋白团块的超声表现和大小与其组织学鉴定和测量直接相关。注射的胶原蛋白产生的炎症反应很小，尽管注射的胶原蛋白有组织成纤维细胞浸润和新生血管形成。与肌层内注射相比，黏膜下胶原蛋白注射导致更长的存留时间。根据我们的研究结果，我们推测胶原蛋白注射治疗尿失禁的持久成功归因于注射胶原蛋白的组织成纤维细胞浸润。当注射的胶原蛋白被肥厚性瘢痕替代时，可能会取得长期临床成功。然而，如果注射的胶原蛋白被挛缩性瘢痕替代，尿道贴合可能无法持续。腔内超声有助于确保胶原蛋白注射准确位于黏膜下，避免材料分散，并应提高尿失禁治疗的疗效。
