Collagen injection therapy for post-radical retropubic prostatectomy incontinence

Role of Valsalva leak point pressure

Ricardo F. Sánchez-Ortiz, Gregory A. Broderick, David Chaikin, S. Bruce Malkowicz, Keith Van Arsdalen, Daniel S. Blander, Alan J. Wein

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Purpose: We retrospectively evaluated the role of Valsalva leak point pressure as a predictor of successful management of post-radical retropubic prostatectomy incontinence with collagen injection. Materials and Methods: Urodynamic studies and Valsalva leak point pressures of 31 men who received retrograde collagen injection for post-radical retropubic prostatectomy incontinence were reviewed. Patients were interviewed before and after treatment to assess pad use and the American Urological Association quality of life index (scale 0 to 6). Parameters for success were postoperative quality of life score 3 or less or 50% or greater decrease in pad use and that the patient would recommend collagen therapy to someone else. Results: Of 31 patients 11 (35%) met the criteria for success, 2 (6%) were completely dry and 9 (29%) were improved. Successfully treated patients had a mean Valsalva leak point pressure of 64.0 cm. water compared to 42.2 cm. water in the failure group (p <0.01). Of patients with Valsalva leak point pressure of 60 cm. water or greater, 70% responded favorably to collagen injection (positive predictive value), while 81% with Valsalva leak point pressure less than 60 cm. water had treatment failure (negative predictive value) (p <0.02). There were no other statistically significant differences between those successfully treated with collagen injection and those in whom treatment failed, including mean age (62.7 to 68.1 years), mean volume of collagen (26.1 to 28.9 ml.), mean number of treatment sessions (2.45 to 2.65), mean followup (14.9 to 15.1 months), preoperative quality of life score (5.1 to 4.9), and preoperative pads per day (4.0 to 3.37). Conclusions: Our data suggest that collagen injection improves 35% but cures a minority of patients (less than 10%) with post-radical retropubic prostatectomy incontinence. A pretreatment Valsalva leak point pressure of 60 cm. water or greater has high predictive value for a beneficial outcome after collagen injection. We propose a role for Valsalva leak point pressure to select men cost-effectively with post-radical retropubic prostatectomy incontinence for therapy with collagen injection.

Original languageEnglish (US)
Pages (from-to)2132-2136
Number of pages5
JournalJournal of Urology
Volume158
Issue number6
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

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Prostatectomy
Collagen
Pressure
Injections
Water
Therapeutics
Quality of Life
Urodynamics
Treatment Failure
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Sánchez-Ortiz, R. F., Broderick, G. A., Chaikin, D., Malkowicz, S. B., Van Arsdalen, K., Blander, D. S., & Wein, A. J. (1997). Collagen injection therapy for post-radical retropubic prostatectomy incontinence: Role of Valsalva leak point pressure. Journal of Urology, 158(6), 2132-2136. https://doi.org/10.1016/S0022-5347(01)68177-1
Sánchez-Ortiz, Ricardo F. ; Broderick, Gregory A. ; Chaikin, David ; Malkowicz, S. Bruce ; Van Arsdalen, Keith ; Blander, Daniel S. ; Wein, Alan J. / Collagen injection therapy for post-radical retropubic prostatectomy incontinence : Role of Valsalva leak point pressure. In: Journal of Urology. 1997 ; Vol. 158, No. 6. pp. 2132-2136.
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title = "Collagen injection therapy for post-radical retropubic prostatectomy incontinence: Role of Valsalva leak point pressure",
abstract = "Purpose: We retrospectively evaluated the role of Valsalva leak point pressure as a predictor of successful management of post-radical retropubic prostatectomy incontinence with collagen injection. Materials and Methods: Urodynamic studies and Valsalva leak point pressures of 31 men who received retrograde collagen injection for post-radical retropubic prostatectomy incontinence were reviewed. Patients were interviewed before and after treatment to assess pad use and the American Urological Association quality of life index (scale 0 to 6). Parameters for success were postoperative quality of life score 3 or less or 50{\%} or greater decrease in pad use and that the patient would recommend collagen therapy to someone else. Results: Of 31 patients 11 (35{\%}) met the criteria for success, 2 (6{\%}) were completely dry and 9 (29{\%}) were improved. Successfully treated patients had a mean Valsalva leak point pressure of 64.0 cm. water compared to 42.2 cm. water in the failure group (p <0.01). Of patients with Valsalva leak point pressure of 60 cm. water or greater, 70{\%} responded favorably to collagen injection (positive predictive value), while 81{\%} with Valsalva leak point pressure less than 60 cm. water had treatment failure (negative predictive value) (p <0.02). There were no other statistically significant differences between those successfully treated with collagen injection and those in whom treatment failed, including mean age (62.7 to 68.1 years), mean volume of collagen (26.1 to 28.9 ml.), mean number of treatment sessions (2.45 to 2.65), mean followup (14.9 to 15.1 months), preoperative quality of life score (5.1 to 4.9), and preoperative pads per day (4.0 to 3.37). Conclusions: Our data suggest that collagen injection improves 35{\%} but cures a minority of patients (less than 10{\%}) with post-radical retropubic prostatectomy incontinence. A pretreatment Valsalva leak point pressure of 60 cm. water or greater has high predictive value for a beneficial outcome after collagen injection. We propose a role for Valsalva leak point pressure to select men cost-effectively with post-radical retropubic prostatectomy incontinence for therapy with collagen injection.",
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Sánchez-Ortiz, RF, Broderick, GA, Chaikin, D, Malkowicz, SB, Van Arsdalen, K, Blander, DS & Wein, AJ 1997, 'Collagen injection therapy for post-radical retropubic prostatectomy incontinence: Role of Valsalva leak point pressure', Journal of Urology, vol. 158, no. 6, pp. 2132-2136. https://doi.org/10.1016/S0022-5347(01)68177-1

Collagen injection therapy for post-radical retropubic prostatectomy incontinence : Role of Valsalva leak point pressure. / Sánchez-Ortiz, Ricardo F.; Broderick, Gregory A.; Chaikin, David; Malkowicz, S. Bruce; Van Arsdalen, Keith; Blander, Daniel S.; Wein, Alan J.

In: Journal of Urology, Vol. 158, No. 6, 01.01.1997, p. 2132-2136.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Collagen injection therapy for post-radical retropubic prostatectomy incontinence

T2 - Role of Valsalva leak point pressure

AU - Sánchez-Ortiz, Ricardo F.

AU - Broderick, Gregory A.

AU - Chaikin, David

AU - Malkowicz, S. Bruce

AU - Van Arsdalen, Keith

AU - Blander, Daniel S.

AU - Wein, Alan J.

PY - 1997/1/1

Y1 - 1997/1/1

N2 - Purpose: We retrospectively evaluated the role of Valsalva leak point pressure as a predictor of successful management of post-radical retropubic prostatectomy incontinence with collagen injection. Materials and Methods: Urodynamic studies and Valsalva leak point pressures of 31 men who received retrograde collagen injection for post-radical retropubic prostatectomy incontinence were reviewed. Patients were interviewed before and after treatment to assess pad use and the American Urological Association quality of life index (scale 0 to 6). Parameters for success were postoperative quality of life score 3 or less or 50% or greater decrease in pad use and that the patient would recommend collagen therapy to someone else. Results: Of 31 patients 11 (35%) met the criteria for success, 2 (6%) were completely dry and 9 (29%) were improved. Successfully treated patients had a mean Valsalva leak point pressure of 64.0 cm. water compared to 42.2 cm. water in the failure group (p <0.01). Of patients with Valsalva leak point pressure of 60 cm. water or greater, 70% responded favorably to collagen injection (positive predictive value), while 81% with Valsalva leak point pressure less than 60 cm. water had treatment failure (negative predictive value) (p <0.02). There were no other statistically significant differences between those successfully treated with collagen injection and those in whom treatment failed, including mean age (62.7 to 68.1 years), mean volume of collagen (26.1 to 28.9 ml.), mean number of treatment sessions (2.45 to 2.65), mean followup (14.9 to 15.1 months), preoperative quality of life score (5.1 to 4.9), and preoperative pads per day (4.0 to 3.37). Conclusions: Our data suggest that collagen injection improves 35% but cures a minority of patients (less than 10%) with post-radical retropubic prostatectomy incontinence. A pretreatment Valsalva leak point pressure of 60 cm. water or greater has high predictive value for a beneficial outcome after collagen injection. We propose a role for Valsalva leak point pressure to select men cost-effectively with post-radical retropubic prostatectomy incontinence for therapy with collagen injection.

AB - Purpose: We retrospectively evaluated the role of Valsalva leak point pressure as a predictor of successful management of post-radical retropubic prostatectomy incontinence with collagen injection. Materials and Methods: Urodynamic studies and Valsalva leak point pressures of 31 men who received retrograde collagen injection for post-radical retropubic prostatectomy incontinence were reviewed. Patients were interviewed before and after treatment to assess pad use and the American Urological Association quality of life index (scale 0 to 6). Parameters for success were postoperative quality of life score 3 or less or 50% or greater decrease in pad use and that the patient would recommend collagen therapy to someone else. Results: Of 31 patients 11 (35%) met the criteria for success, 2 (6%) were completely dry and 9 (29%) were improved. Successfully treated patients had a mean Valsalva leak point pressure of 64.0 cm. water compared to 42.2 cm. water in the failure group (p <0.01). Of patients with Valsalva leak point pressure of 60 cm. water or greater, 70% responded favorably to collagen injection (positive predictive value), while 81% with Valsalva leak point pressure less than 60 cm. water had treatment failure (negative predictive value) (p <0.02). There were no other statistically significant differences between those successfully treated with collagen injection and those in whom treatment failed, including mean age (62.7 to 68.1 years), mean volume of collagen (26.1 to 28.9 ml.), mean number of treatment sessions (2.45 to 2.65), mean followup (14.9 to 15.1 months), preoperative quality of life score (5.1 to 4.9), and preoperative pads per day (4.0 to 3.37). Conclusions: Our data suggest that collagen injection improves 35% but cures a minority of patients (less than 10%) with post-radical retropubic prostatectomy incontinence. A pretreatment Valsalva leak point pressure of 60 cm. water or greater has high predictive value for a beneficial outcome after collagen injection. We propose a role for Valsalva leak point pressure to select men cost-effectively with post-radical retropubic prostatectomy incontinence for therapy with collagen injection.

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