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Am Fam Physician. 2000;62(11):2497

There has been an increasing awareness that urinary incontinence is not a part of the natural aging process in women. Many patients are now seeking medical treatment for incontinence, including elderly women. Because of concomitant comorbidities in these elderly women, surgical intervention can result in more risk to the patient than is acceptable. One alternative in this group is collagen injection therapy. This procedure can be performed in an outpatient setting with minimal risk to patients. Winters and colleagues evaluated the long-term results of collagen injection therapy in the treatment of urinary incontinence in elderly women.

Women 65 years and older with an established diagnosis of stress urinary incontinence were considered for the study. A routine preoperative evaluation, including urodynamics, was performed before the procedure. Eighty-five percent of the patients had intrinsic sphincteric deficiency, while 15 percent had genuine stress urinary incontinence. The Q-tip test confirmed that 64 percent had urethral hypermobility.

In the initial response to collagen injection therapy, 48.3 percent of the patients were totally dry and 31.0 percent were socially continent at two months. At a mean follow-up of 24 months, of those who had developed continence after the procedure, 41.3 percent required repeat injections. The long-term success rate after repeat injections was 60.3 percent. Most of the patients contacted in follow-up noted an improvement in their symptoms and their quality of life. They also reported minimal discomfort with the procedure and would recommend the treatment.

The authors conclude that collagen injection therapy for the treatment of stress incontinence in elderly women is a safe and moderately effective alternative to surgical intervention. Discussions with elderly women about this procedure should include the information that approximately 40 percent experience recurrent leakage and that this leakage may not resolve with reinjection.

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