Collagen injection for urinary incontinence


From ACOG - Philadelphia, Pennsylvania - May, 1999

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Dr. Jeff Levy: "I'm Jeff Levy, and I'm the Director of Medical Education for IMET - Innovations in Medical Education and Training. We're here at the ACOG booth, at the 47th annual ACOG meeting, and we've just finished a lecture on collagen injections in the practice of urogynecology. Richard Scottie, who's Associate Professor at Albert Einstein Medical Center and at Montefiore Hospital in the Bronx, gave the lecture and wants to give us a few tips on how to use collagen and what it can do for our patients."

Dr. Richard Scotti: "Thank you, Jeff. As you know, collagen came on the scene about five years ago, and it really filled the gap that needed to be filled. There are a number of people who develop urinary incontinence who have a well-supported bladder neck so surgical approaches will not work for them. In fact, their problem is primary urethral dysfunction. It used to be called "urethral insufficiency," now we call it "intrinsic sphincteric deficiency." Something's wrong with the sphincteric mechanism, and the way we diagnose these people is to measure urethral pressure or leak point pressure - two urodynamic tests to determine whether or not they have this problem. If they have that combined with no real anatomic descent of the bladder neck, they're candidates for collagen."

Dr. Jeff Levy: "In your lecture, you also talked about some of the issues with slings. What are appropriate patients for sling procedures?"

Dr. Richard Scotti: "A sling operation works best on a person who has intrinsic sphincter deficiency but a lot of hypermobility because the sling combines increasing urethral outflow resistance with elevating the bladder neck, where as collagen just helps to increase the outflow resistance by injection under the mucosa of the urethra at about the level of the bladder neck or even further down."

Dr. Jeff Levy: "One of the things that we try to do at IMET is to run some very high level educational courses with a lot of hands on experience for our physicians. I know you're running a course in a couple of weeks in June, in New York. Why don't you tell the audience a little bit about that course."

Dr. Richard Scotti: "We've tried to get some of the leading experts in urogynecology, so there'll be Alfred Bent, who's at the Greater Baltimore Medical Center - he's written a couple of textbooks actually, and Dr. David Staskin, a urologist. So we have a blend of gynecologists - Dr. Bent and myself, and urologists - Dr. Staskin and Dr. Whitmore. What we hope to do is give a real good scientific basis for incontinence and pelvic floor prolapse with a lot of practical hands on experience. That will include a number of laboratories rotating through different stations, urodynamics, some of the newer technologies, surgical technologies, and it's potentially going to be a great program. I'm very enthusiastic about it as you know, and I think that we'll have a very successful program, and hopefully, the participants will take away something they can use in their practices."

Dr. Jeff Levy: "One last thing, you're including some musical expertise in this conference too. Why don't you just tell us a little about that."

Dr. Richard Scotti: "Of course, any conference needs some entertainment, and I have been a professional jazz musician for most of my life, longer than I've been a physician - so we put the program together called, "Jazz Greats of New York." I have Ray Gomez on the base - who has played with Benny Goodman, Jerry Mulligan, Miles Davis - he's one of the real "working-est" base players in New York. I have Elliott Zigman on the drums - who's also played with Bill Evans who did some amazing work after he left Miles, and I have an excellent piano player. And there are two physicians up front playing the horns, and I just don't play with doctors because they're doctors - they've got to be good, and Dr. Morantz is a fantastic alto sax player. We're going to do tunes that represent New York as the jazz capital of the world."

Dr. Jeff Levy: "That's great - we're looking forward to it, and thank you very much for participating in our educational program here at IMET."

Dr. Richard Scotti: "Thank you, my pleasure."

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