Christoph F, Moschkowitsch A, Kempkensteffen C, Schostak M, Miller K, Schrader M
Department of Urology, Charité - Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Urol Int. 2007;79(1):55-9. doi: 10.1159/000102915.
We investigated the effects of standard oral anticholinergic treatment with tolterodine in children with neurogenic bladder over a 5-year follow-up period and focused on treatment satisfaction, patient compliance and urodynamic parameters.
The follow-up consisted of regular visits and urodynamic evaluation at least once a year. The patients or their parents were interviewed to evaluate voiding behavior, as well as factors leading to lower patient compliance and deterioration in urodynamic parameters.
Of the 43 patients evaluated, 30 (70%) took their anticholinergic medication consistently and 13 (30%) sporadically. The mean bladder capacity was 354.7 ml in the first group but only 214.7 ml in the noncompliant group (p < 0.001). The mean maximal detrusor pressure decreased from 42.2 to 33.6 cm H(2)O in the compliant group (p < 0.001) and from 49.7 to 46.4 cm H(2)O in the noncompliant group (p = 0.21). The mean detrusor compliance increased from 18.9 to 19.3 ml/cm H(2)O in the compliant group (p = 0.63) and from 11.8 to 12.3 ml/cm H(2)O in the noncompliant group (p = 0.87). Side effects such as dry mouth (11/13) and dizziness (7/13) were common in the noncompliant group, whereas only 5/30 reported dry mouth in the compliant group.
These data demonstrate the efficacy and tolerability of tolterodine over a long follow-up period. The results are promising in view of the fact that the patients will probably require life-long medication. Nevertheless, anticholinergic side effects still cause some patients to refuse regular medication, which results in a poorer urodynamic outcome.
我们对托特罗定标准口服抗胆碱能治疗对神经源性膀胱患儿的影响进行了为期5年的随访研究，并重点关注治疗满意度、患者依从性和尿动力学参数。
随访包括每年至少进行一次定期就诊和尿动力学评估。对患者或其父母进行访谈，以评估排尿行为，以及导致患者依从性降低和尿动力学参数恶化的因素。
在评估的43例患者中，30例（70%）持续服用抗胆碱能药物，13例（30%）偶尔服用。第一组的平均膀胱容量为354.7毫升，而不依从组仅为214.7毫升（p<0.001）。依从组的平均最大逼尿肌压力从42.2厘米水柱降至33.6厘米水柱（p<0.001），不依从组从49.7厘米水柱降至46.4厘米水柱（p = 0.21）。依从组的平均逼尿肌顺应性从18.9毫升/厘米水柱增加到19.3毫升/厘米水柱（p = 0.63），不依从组从11.8毫升/厘米水柱增加到12.3毫升/厘米水柱（p = 0.87）。不依从组口干（11/13）和头晕（7/13）等副作用常见，而依从组只有5/30报告有口干。
这些数据证明了托特罗定在长期随访中的疗效和耐受性。鉴于患者可能需要终身服药，这一结果很有前景。然而，抗胆碱能副作用仍导致一些患者拒绝规律服药，从而导致尿动力学结果较差。
