Medical Reading

Calcification Of Glutaraldehyde Cross-Linked Collagen In Bladder Neck Injections In Children With Incontinence: A Long-Term Complication

August 14, 2017

UroToday - Collagen injections are routinely used to treat urinary incontinence. Knudson et al report their experience of the developing calcifications at the bladder neck/urethra in pediatric patients treated with glutaraldehyde cross-linked collagen for urinary incontinence. They reviewed the charts of patients treated between 1994 and 1999. The etiology of incontinence, pertinent medical history, operative details and postoperative imaging were detailed.

Of the 31 patients, 4 (13%) had developed submucosal calcifications in the bladder neck/urethra. All 4 patients had received multiple injections of glutaraldehyde cross-linked collagen for incontinence secondary to a neuropathic bladder. All the calcified collagen was surgically excised and the pathology reports available for 2 of 4 patients showed chronic inflammation without dysplasia or malignant changes. The total volume of injected material was significantly different between calcified and noncalcified cases (21 vs 12 cc respectively, p = 0.012). Mean time to diagnosis of calcifications was 8.8 years (range 7 to 11) after first injection. The number of injections was not significantly different between the 2 groups (p = 0.426).

An editorial comment by Dr. Linda Shortliffe stated that this was documentation of a new late complication (noted almost 10 years after injection) in 13% of children treated with glutaraldehyde cross-linked collagen. She emphasized that longer follow up is needed because 10 years in children is not long at all, and further states that the reporting of "late complications" following procedures performed in children occurring 10, 20 or 30 years after puberty, pregnancy and aging is paramount.

By: P Casale

Journal of Urology, 176(3): 1143-1146, September 2006.
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