Kim Y H, Kattan M W, Boone T B
Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA.
Urology. 1997 Dec;50(6):941-8. doi: 10.1016/S0090-4295(97)00460-3.
We correlated preoperative urodynamic and intraoperative endoscopic findings with initial improvement, single collagen injection effectiveness for intrinsic sphincter deficiency (ISD), and long-term improvement following transurethral collagen injection for stress urinary incontinence (SUI).
Since 1993, 79 patients have been treated with transurethral collagen injection by the same urologist. Of these patients, intraoperative photographs of urothelial coaptation immediately after injection were available in 67 patients: 35 women with ISD, 24 men with incontinence, primarily following prostatectomy, and 8 children with neurogenic bladder. Urothelial coaptation was described as snug, fair, or poor. Preoperative Valsalva leak point pressure (VLPP), detrusor instability, impaired bladder compliance, bladder neck appearance, urothelial scarring, and degree of coaptation were correlated with both initial and long-term improvement. Initial improvement was compared with long-term improvement.
Initial improvement was experienced by 85% of all the subjects (86%) of the women, 80% of the men, and 100% of the children with a neurogenic bladder condition). Overall, 31% of patients had long-term improvement after a mean follow-up of 2.2 years, including 43% of the women, 13% of the men, and 33% of the children. The patients underwent a mean of 1.5 (1 to 4) collagen injections. There was a significant correlation between degree of coaptation and initial improvement (P = 0.003), but not with long-term improvement. There was no correlation between VLPP detrusor instability, impaired compliance, bladder neck appearance, or urethral scarring and initial improvement. There was no correlation between any parameter and long-term improvement or between initial and long-term improvement.
Initial endoscopic appearance following collagen injection predicted initial, but not long-term, improvement after one collagen injection. Initial improvement was high in both men and women but decreased considerably over time, more so in men, and was not significantly correlated with long-term success. Urodynamic and endoscopic findings do not predict long-term success following collagen injection.
我们将术前尿动力学检查结果及术中内镜检查结果与初始改善情况、单一胶原注射治疗固有括约肌缺陷（ISD）的有效性以及经尿道胶原注射治疗压力性尿失禁（SUI）后的长期改善情况进行了关联分析。
自1993年以来，同一位泌尿外科医生对79例患者进行了经尿道胶原注射治疗。其中，67例患者有注射后即刻的尿路上皮贴合术中照片：35例患有ISD的女性、24例主要在前列腺切除术后出现尿失禁的男性以及8例患有神经源性膀胱的儿童。尿路上皮贴合情况被描述为紧密、一般或较差。术前的瓦尔萨尔瓦漏尿点压力（VLPP）、逼尿肌不稳定、膀胱顺应性受损、膀胱颈外观、尿路上皮瘢痕形成及贴合程度与初始及长期改善情况相关。对初始改善情况与长期改善情况进行了比较。
所有受试者中，85%（女性为86%，男性为80%，患有神经源性膀胱疾病的儿童为100%）有初始改善。总体而言，平均随访2.2年后，31%的患者有长期改善，其中女性为43%，男性为13%，儿童为33%。患者平均接受了1.5（1至4）次胶原注射。贴合程度与初始改善情况之间存在显著相关性（P = 0.003），但与长期改善情况无关。VLPP与逼尿肌不稳定、顺应性受损、膀胱颈外观或尿道瘢痕形成与初始改善情况之间无相关性。任何参数与长期改善情况之间或初始与长期改善情况之间均无相关性。
胶原注射后的初始内镜表现可预测单次胶原注射后的初始改善情况，但不能预测长期改善情况。男性和女性的初始改善率均较高，但随着时间推移显著下降，男性下降更明显，且与长期成功率无显著相关性。尿动力学和内镜检查结果不能预测胶原注射后的长期成功率。
