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A small but significant subset of patients with lower urinary tract dysfunction secondary to neurogenic etiology develop intrinsic sphincter deficiency (ISD). This is manifested clinically as stress urinary incontinence. We sought to evaluate the efficacy of transurethral collagen injections in the management of ISD of neuropathic origin in the male patient. A retrospective chart review over a 3-year period revealed 11 patients who underwent between one and three collagen injections for ISD. Follow-up data were available for 9 patients. Preoperative symptoms and urodynamic studies as well as postoperative symptoms were recorded. The majority of our patients (67%) had symptomatic improvement of their urinary incontinence. Although more long-term data are needed, this method appears to be a viable alternative for the male patient with neurogenic ISD.