Department of Urology, St. Hedwig Hospital, Medical School of Charité Universitätsmedizin, 10115 Berlin, Germany.
J Pediatr Urol. 2012 Aug;8(4):386-92. doi: 10.1016/j.jpurol.2011.07.014. Epub 2011 Sep 9.
To evaluate prospectively the efficacy and tolerability of propiverine for long-term treatment of neurogenic detrusor overactivity (NDO) in children.
17 children and adolescents with NDO (10 female, 7 male; average age at last consultation 13.0 years) were evaluated during long-term treatment with propiverine (0.8 mg/kg body weight/day). Outcome measurements included urodynamic parameters, continence, hydronephrosis and tolerability of propiverine.
Average follow-up was 3.6 years (range 2.0-5.9). The average maximum detrusor pressure was 33.2 ± 4.8 cmH(2)O and bladder compliance was 20.0 ± 5.4 ml/cmH(2)O at the last follow-up visit. Maximum cystometric bladder capacity (MCBC) within the normal range was attained in 11 patients; it was still reduced (average of 61% of expected MCBC) in the remaining 6. Incontinence occurred on average once per day. Hydronephrosis was classified for each renal unit separately: grade 0 was measured in 26 and 22 cases, grade 1 or 2 in 6 and 8 cases, grade 3 or 4 in 2 and 4 cases pre and post treatment, respectively. In 6/17 patients adjuvant intravesical oxybutynin was applied, in 4 out of these 6 patients more invasive procedures, such as untethering, augmentation cystoplasty or botulinum toxin injections, were necessitated. Propiverine monotherapy was well tolerated in 11/17 patients. No serious adverse events were encountered during the study period.
Long-term efficacy and tolerability of propiverine for NDO in children and adolescents is promising: clinically relevant improvements in key urodynamic outcomes were paralleled by improvements in incontinence score.
前瞻性评估丙哌维林治疗儿童神经源性逼尿肌过度活动（NDO）的疗效和耐受性。
17 名 NDO 患儿和青少年（10 名女性，7 名男性；末次就诊时平均年龄 13.0 岁）接受丙哌维林（0.8mg/kg 体重/天）长期治疗，进行疗效评估。评估指标包括尿动力学参数、控尿情况、肾积水和丙哌维林的耐受性。
平均随访时间为 3.6 年（2.0-5.9 年）。最后一次随访时，平均最大逼尿肌压力为 33.2±4.8cmH₂O，膀胱顺应性为 20.0±5.4ml/cmH₂O。11 名患者达到最大膀胱容量正常范围，其余 6 名患者仍存在膀胱容量减少（平均为预计最大膀胱容量的 61%）。平均每天遗尿 1 次。分别对每个肾脏单位的肾积水进行分级：治疗前、后分别有 26 例和 22 例为 0 级，6 例和 8 例为 1 级或 2 级，2 例和 4 例为 3 级或 4 级。17 例患者中有 6 例接受了辅助膀胱内奥昔布宁治疗，其中 4 例患者需要进行更具侵袭性的治疗，如松解术、膀胱扩大术或肉毒杆菌毒素注射。11/17 例患者对丙哌维林单药治疗耐受良好。研究期间未发生严重不良事件。
丙哌维林治疗儿童和青少年 NDO 的长期疗效和耐受性较好：关键尿动力学指标的临床相关改善与遗尿评分的改善相平行。
