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Periurethral collagen implant: Ultrasound assessment and prediction of outcome

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Abstract

The objective of this study was to identify sonographic parameters that could predict sucessful outcome in women after periurethral collagen implant. Thirty-one women with a diagnosis of stress urinary incontinence with intrinsic sphincteric deficiency underwent one periurethral collagen implant between January and December 1994. Three months after the procedure ultrasound evaluation was performed using a 5 MHz probe placed at the vaginal introitus. Subjective assessment and cough stress test were used to measure outcomes. Twenty-five women were available for evaluation 1 year after the procedure. A successful outcome was found in 18 of the 25 women subjectively (72%) and in 16 objectively (64%). A distance of the collagen from the bladder neck of less than 7 mm was found to be associated with a positive outcome. This threshold was found to have a sensitivity of 83.3%, specificity of 85.7%, a positive predictive value of 93.7% and a negative predictive value of 66.6%.

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Authors and Affiliations

  1. Department Of Obstetrics and Gynecology, State University of New York, 736 Irving Ave., Room 3654 West Tower, Syracuse, NY13210, USA

    G. Elia

  2. Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA

    A. Bergman

Authors
  1. G. Elia
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  2. A. Bergman
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EDITORIAL COMMENT: We know very little about why collagen injection at the bladder neck works or what makes it produce continence, especially in the long term. The height of the ‘bumps’, the location of the injection as determined by ultrasound, and finally the degree of vascularization of the material may all be important. Further studies are needed to elucidate these points in greater detail, especially at 1 year or more. It is difficult in this study to determine whether the patients had a well supported bladder neck, as the results of the Q-tip test are not given: Q-tip results should always be reported in terms of degrees from the horizontal, as a angle change of 60°–70° is only 10° and could indicate hypomobility. But isn't a resting angle of 60° from the horizontal already indicative of urethralhypermobility? As a final point, we know that Valsalva leak-point pressures are useful in determining the need for collagen injection in patients with ISD and urethral hypermobility, and that a value of less than 65 cmH2O has validity. Where does the new figure of 100 cmH2O fit in, as was recently announced by the manufacturer of the collagen implant? Valsalva leak-point pressure usefulness in selecting other forms of surgical procedures for continence remains to be proven, and this test should not be given the same significance as low urethral close pressure, whose clinical predictive value is well established, when other surgical procedures are considered.

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Elia, G., Bergman, A. Periurethral collagen implant: Ultrasound assessment and prediction of outcome. Int Urogynecol J 7, 335–338 (1996). https://doi.org/10.1007/BF01901110

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  • DOI: https://doi.org/10.1007/BF01901110

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