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Urodynamic effects of propiverine hydrochloride in children with neurogenic detrusor overactivity: a prospective analysis
Author(s) -
SCHULTEBAUKLOH HEINRICH,
MÜRTZ GERD,
HENNE THOMAS,
MICHAEL THEODOR,
MILLER KURT,
KNISPEL HELMUT H.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.05953.x
Subject(s) - medicine , tolerability , urology , percutaneous , urinary incontinence , regimen , prospective cohort study , anesthesia , surgery , adverse effect
The management of stones in children is often controversial; extracorporeal shock wave lithotripsy appears to be very successful, with excellent clearance rates, and probably better than in adults. For this reason, many maintain that percutaneous nephrolithotripsy might not be required in children. Authors from Pakistan retrospectively assessed their use of percutaneous nephrolithotripsy, finding that it too yields satisfactory results. OBJECTIVES To evaluate prospectively the efficacy and tolerability of propiverine for treating neurogenic detrusor overactivity (NDO) in children. PATIENTS AND METHODS Twenty children (mean age 8.9 years; median 5.6) with NDO due to an upper motor neurone lesion were enrolled (17 had myelomeningocele). In the urodynamic examination, reflex volume (RV), maximum detrusor pressure (MDP), maximum cystometric bladder capacity (MCBC) and bladder compliance (BC) before and after a twice‐daily propiverine hydrochloride regimen were determined. The urodynamic follow‐up was after 3–6 months. Incontinence was assessed by an incontinence score. RESULTS The mean ( sem ) RV increased from 103.8 (21.3) to 174.5 (33.7) mL ( P < 0.005), MDP decreased from 52.5 (7.9) to 40.1 (6.2) cmH 2 O ( P < 0.05), MCBC increased from 166 (28.8) to 231.9 (34.8) mL ( P < 0.005), and BC improved from 11.2 (2.8) to 30.6 (9.7) mL/cmH 2 O ( P < 0.01), with propiverine treatment. The incontinence score (scale 0–3) improved from 2.4 (0.2) to 1.6 (0.3) ( P < 0.05). Propiverine was well tolerated, although some children were given higher doses than recommended. CONCLUSIONS Propiverine hydrochloride is effective and well tolerated in the treatment of children with NDO. Because of its dual mode of action, it is well tolerated even in children who need higher doses. Propiverine hydrochloride is a preferable alternative to oxybutynin, the anticholinergic most frequently used in children with NDO to date.