GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up.

OBJECTIVE

To determine the efficacy of GAX collagen in the treatment of elderly women with genuine stress incontinence.

DESIGN

A single centre prospective study.

SETTING

A London teaching hospital.

PARTICIPANTS

Thirty-four women older than 60 years of age with genuine stress incontinence diagnosed on videocystourethrography.

INTERVENTIONS

Up to three paraurethral injections of GAX collagen.

MAIN OUTCOME MEASURES

Subjective and pad test assessments performed pre-operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre-operatively, after three months and one year.

RESULTS

There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre-treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size.

CONCLUSION

GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.