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Collagen injections for incontinence. Has anyone used this method?

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Posted 11/25/2011 2:27 PM (GMT 0)
Hi guys,
Well after two years of leaking following my Da Vinci surgery, I have had it!!!
Being the coward that I am, I really don't want to have the Advance male sling implanted if it can possibly be avoided. My Uro is also not inclined to do the sling and has suggested collagen injections to bulk up around the bladder neck. My leaking is less than two pads per day and I am totally dry at night. My doc seems to think the collagen could stop the leaking.
Has anyone used this method to stop your incontinence?

Thanks for your input.
Len
Posted 11/25/2011 11:42 PM (GMT 0)
I tried both the Collagen and Teflex bulking with two different urologist.  My primary, who did the RP, tried it 2 different times, both times with collagen were unsuccesful. 

The secondary urologist, unfortunately the primary had health problems and had to retire, used Teflex which is the teflon coated carbon particles.  This also was not successful.

All three of the above could have been due to scar tissue problems and rotorrooter work done to clear the strictures.

The 3rd Urologist - original partner of the other two ( I go through them like crazy but the 2nd guy went to a larger practice so he had time off)had tried bulking in 1999 to 2004 and did not have results which procedure warranted. 

With the last stricture removal (I had 4 in 10 years), Dr Stanley and I discussed:

          Bulking - which he did not have good empirical results when he used the procedure 1999-2004

          Sling - I was too far gone - leaking too much and wouldn't be satisfied with results

          AMS 800 -  which he had good success but referred me to Cleveland Clinic.

                   He could implant but felt Cleveland did more and were the best choice in the area.

                   I had Dr Montague, Director of Urological Surgery, great guy and great place. - don't look back great

I did lots of reading and my case may have been difficult due to scar tissue.  Both Urologist who did the procedure thought it would work and had some success.

Personnally, I would get a second opinion and have some flow studies done.

  Bio-Feedback( anal stimulator - hurts like hell but works Microgyn Plus)  and Kegel Training really helped me until I had the strictures

Good Luck with your decision.  

Tom of Ohio

 

Posted 11/26/2011 2:05 AM (GMT 0)
My original uro wanted to try it, but I read too many negatives & failures with it.

 

Posted 11/26/2011 1:28 PM (GMT 0)
Thanks guys. I can't believe there aren't more guys out there that haven't tried bulking with collagen. Gene, what are some of the negatives you heard?
Posted 11/26/2011 2:35 PM (GMT 0)
You may want to do google search on Collagen /Teflex (Teflon coated Carbon) - Collagen Bulking for Urinary Continence Success Rate.

The one study done in 2005 showed less than 25% success rate after 2years with bulking in Men. Women may have higher success rate. The gold standard for incontinence is the Artificial Sphincter.

Male Incontinence 2005 study
Closer examination of men with ISD resulted in several observations.22–25 Patients with severe incontinence were unlikely to enjoy significant success with bulking therapy. Bladder neck contractures and scarring were associated with poorer continence status postoperatively. Unfortunately, men suffering from ISD were likely to be either postsurgical or postirradiation patients in whom scarring was often present. An antegrade implant method via a suprapubic tract proved superior in terms of finding a tissue plane that could accommodate implantation of a bulking agent. Yet durability of the implant still remained an issue even with this alternative implant technique (Table 3).
This is 2011 info
In women with urethral hypermobility–induced ISD, early studies have reported favorable short-term results with injectables; however, long-term (>1 y) data are lacking. Incontinent men who fare best with injectable therapy are those who have SUI after transurethral prostatectomy (TURP). Men with SUI after radical prostatectomy have the least significant success rate with bulking agents, and these men may be treated best with a sling procedure or an artificial urinary sphincter.[9]

There are more studies but allot of it depends on how you were treated for PC - radiation, RP etc. The questions you need to ask are:
1) Success rate urologist has had with bulking in MEN!
2) When was the bulking successful - procedural dependent - RP does not work or may not work, radiation better chance. Are you a good candidate based on your original procedure?
3) How long has urologist been using bulking in MEN and what was the length of success - years?
4) Cost of bulking vs, sling, vs sphincter - surprisingly the sling and sphincter may not be more costly than bulking.
5) Are you being objective on type of treatment - in 2001-2002, I read about sling and sphincter and didn't feel there was enough imperical data. I just wanted it fixed and any EASY hope I would try.
I have the sphincter now and it wasn't bad at all. Little getting used to, I have had for 9 months and getting easier and easier to use.

Like I stated, a second opinion from perferably a TEACHING hospital like Cleveland Clinic, Mayo, etc maybe worth before you do the next step.

Good Luck, we all know who have incontinence the frustration of it and having grandkids being pottied trained and Grandpa isn't.

Tom of OHio
Posted 11/26/2011 2:35 PM (GMT 0)
You may want to do google search on Collagen /Teflex (Teflon coated Carbon) - Collagen Bulking for Urinary Continence Success Rate.

The one study done in 2005 showed less than 25% success rate after 2years with bulking in Men. Women may have higher success rate. The gold standard for incontinence is the Artificial Sphincter.

Male Incontinence 2005 study
Closer examination of men with ISD resulted in several observations.22–25 Patients with severe incontinence were unlikely to enjoy significant success with bulking therapy. Bladder neck contractures and scarring were associated with poorer continence status postoperatively. Unfortunately, men suffering from ISD were likely to be either postsurgical or postirradiation patients in whom scarring was often present. An antegrade implant method via a suprapubic tract proved superior in terms of finding a tissue plane that could accommodate implantation of a bulking agent. Yet durability of the implant still remained an issue even with this alternative implant technique (Table 3).
This is 2011 info
In women with urethral hypermobility–induced ISD, early studies have reported favorable short-term results with injectables; however, long-term (>1 y) data are lacking. Incontinent men who fare best with injectable therapy are those who have SUI after transurethral prostatectomy (TURP). Men with SUI after radical prostatectomy have the least significant success rate with bulking agents, and these men may be treated best with a sling procedure or an artificial urinary sphincter.[9]

There are more studies but allot of it depends on how you were treated for PC - radiation, RP etc. The questions you need to ask are:
1) Success rate urologist has had with bulking in MEN!
2) When was the bulking successful - procedural dependent - RP does not work or may not work, radiation better chance. Are you a good candidate based on your original procedure?
3) How long has urologist been using bulking in MEN and what was the length of success - years?
4) Cost of bulking vs, sling, vs sphincter - surprisingly the sling and sphincter may not be more costly than bulking.
5) Are you being objective on type of treatment - in 2001-2002, I read about sling and sphincter and didn't feel there was enough imperical data. I just wanted it fixed and any EASY hope I would try.
I have the sphincter now and it wasn't bad at all. Little getting used to, I have had for 9 months and getting easier and easier to use.

Like I stated, a second opinion from perferably a TEACHING hospital like Cleveland Clinic, Mayo, etc maybe worth before you do the next step.

Good Luck, we all know who have incontinence the frustration of it and having grandkids being pottied trained and Grandpa isn't.

Tom of OHio
Posted 5/10/2017 1:01 AM (GMT 0)
Frankly i'm surprised anyone would even hesitate. Most doctors have a huge conflict of interest when they talk down bulk injection therapy. Why on earth would you avoid a non-invasive procedure even with low success rate in favor of real surgery with real risk! While doctors like to point to the low cure rate, its still a cure for a substantial number of patients. What Doctors are offering is usually just a ticket to recurring problems and years of revision surgery, specially if your a diabetic like me. Read the studies for yourself and don't fall for the Doctors " happy talk".
You could be one of the lucky ones but even if your not, you might be better off. They consider it a failure if you have to redo it every year. Compared to an foreign device implanted in me , I consider that the best of successes. If your doctors can't perform bulk agent injections much cheaper than real surgery, you need another doctor.

Post Edited (johnG) : 5/9/2017 8:46:24 PM (GMT-6)

Posted 5/10/2017 5:47 PM (GMT 0)
My boyfriend got excellent results with the sling. Life changing for him. It's not a big deal to get implanted. You want to make sure you have an experienced doctor. Don't necessarily rule it out. My boyfriend put it off for a while as well, but finally got sick of leaking.
Posted 5/10/2017 5:59 PM (GMT 0)
HEADS-UP

This is a 6-year old thread that somehow got resuscitated.

DNR. Check the refrigerator door.
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