Korean J Urol.  2012 Apr;53(4):275-279.

Efficacy and Safety of Propiverine in Children with Overactive Bladder

• Kim WJ
• Lee DG
• Lee SW
• Lee YK
• Lee JS
• Park KH
• Baek M

Abstract

PURPOSE
Antimuscarinic therapy remains one of the most common forms of therapy for overactive bladder (OAB) in children. However, few clinical studies on the outcomes of antimuscarinics in children with OAB have been published. Therefore, we evaluated the efficacy and safety of propiverine, which is frequently prescribed for the treatment of pediatric OAB.
MATERIALS AND METHODS
We retrospectively reviewed children with OAB treated with propiverine within the past 5 years. The response rates were compared between the non-urge incontinence (non-UI) and urge incontinence (UI groups). The cumulative response rate by treatment duration was also compared between the two groups.
RESULTS
Among a total of 68 children, 50 children (73.5%) experienced UI. The overall response rate was 86.8%. Functional bladder capacity after treatment was 150 ml, which represented an increase compared with the value (140 ml) before treatment. The voiding frequency per day decreased from 14.0 to 8.5 times. The overall response rate (88.0%) in the non-UI group was not significantly different from that seen in the UI group (83.3%; p>0.05). In non-UI children, the cumulative response rates were 36.0%, 54.0%, 68.0%, 74.0%, 76.0%, and 78.0% at 4, 8, 12, 16, 20, and 24 weeks, respectively. The cumulative response rates in the UI children were 11.1%, 33.3%, 44.4%, 50.0%, 50.0%, and 55.6%, respectively during the same respective time periods. Adverse effects were identified in only two (2.9%) patients, and neither case was severe.
CONCLUSIONS
Propiverine is effective and well tolerated as a treatment for children suffering from OAB with or without UI.

Keyword

Children; Incontinence; Overactive bladder; Propiverine

MeSH Terms

Benzilates
Child
Humans
Muscarinic Antagonists
Retrospective Studies
Stress, Psychological
Urinary Bladder
Urinary Bladder, Overactive
Urinary Incontinence, Urge
Benzilates
Muscarinic Antagonists

Figure

• 

  FIG. 1 Changes in voiding frequency and maximum voided volume after propiverine treatment. (A) Change in voiding frequency. (B) Change in functional bladder capacity. UI, urge incontinence.

• 

  FIG. 2 Symptom improvement rate of propiverine treatment. Nonresponse, 0 to 49% decrease; Partial response, 50 to 99% decrease; Full response, 100% decrease in incontinence or less than 1 incontinence incident monthly. UI, urge incontinence.

• 

  FIG. 3 Symptom improvement rate of treatment with respect to duration of treatment. UI, urge incontinence.

Reference

1. Kwak KW, Park KH. Clinical inconsistency of lower urinary tract symptoms between questionnaire and bladder diary in children with nocturnal enuresis. J Urol. 2008. 180:1085–1089.

2. Link CL, Lutfey KE, Steers WD, McKinlay JB. Is abuse causally related to urologic symptoms? Results from the Boston Area Community Health (BACH) Survey. Eur Urol. 2007. 52:397–406.

3. Hellström AL, Hanson E, Hansson S, Hjälmås K, Jodal U. Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr. 1990. 149:434–437.

4. Kajiwara M, Inoue K, Kato M, Usui A, Kurihara M, Usui T. Nocturnal enuresis and overactive bladder in children: an epidemiological study. Int J Urol. 2006. 13:36–41.

5. Chung JM, Lee SD, Kang DI, Kwon DD, Kim KS, Kim SY, et al. Prevalence and associated factors of overactive bladder in Korean children 5-13 years old: a nationwide multicenter study. Urology. 2009. 73:63–67.

6. Franco I. Overactive bladder in children. Part 1: pathophysiology. J Urol. 2007. 178(3 Pt 1):761–768.

7. Saini R, Gonzalez RR, Te AE. Chronic pelvic pain syndrome and the overactive bladder: the inflammatory link. Curr Urol Rep. 2008. 9:314–319.

8. Steers WD. Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol. 2002. 4:Suppl 4. S7–S18.

9. Hellström AL. Pathophysiology ochildren with dysfunctional bladder. Scand J Urol Nephrol Suppl. 1992. 141:106–107.

10. Diokno AC, Appell RA, Sand PK, Dmochowski RR, Gburek BM, Klimberg IW, et al. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clin Proc. 2003. 78:687–695.

11. Madersbacher H, Mürtz G. Efficacy, tolerability and safety profile of propiverine in the treatment of the overactive bladder (non-neurogenic and neurogenic). World J Urol. 2001. 19:324–335.

12. Kreder K, Mayne C, Jonas U. Long-term safety, tolerability and efficacy of extended-release tolterodine in the treatment of overactive bladder. Eur Urol. 2002. 41:588–595.

13. Zinner N, Gittelman M, Harris R, Susset J, Kanelos A, Auerbach S, et al. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol. 2004. 171(6 Pt 1):2311–2315.

14. Chapple CR, Rechberger T, Al-Shukri S, Meffan P, Everaert K, Huang M, et al. Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int. 2004. 93:303–310.

15. Hoebeke P, De Pooter J, De Caestecker K, Raes A, Dehoorne J, Van Laecke E, et al. Solifenacin for therapy resistant overactive bladder. J Urol. 2009. 182:4 Suppl. 2040–2044.

16. Um JM, Kim KM. Efficacy and tolerability of extended-release oxybutynin in children with a neurogenic bladder. Korean J Urol. 2007. 48:1064–1068.

17. Alloussi S, Mürtz G, Braun R, Gerhardt U, Heinrich M, Hellmis E, et al. Efficacy, tolerability and safety of propiverine hydrochloride in comparison to oxybutynin in children with urge incontinence due to overactive bladder: results of a multicentre observational cohort study. BJU Int. 2010. 106:550–556.

18. Marschall-Kehrel D, Feustel C, Persson de Geeter C, Stehr M, Radmayr C, Sillén U, et al. Treatment with propiverine in children suffering from nonneurogenic overactive bladder and urinary incontinence: results of a randomized placebo-controlled phase 3 clinical trial. Eur Urol. 2009. 55:729–736.

19. Wada Y, Yoshida M, Kitani K, Kikukawa H, Ichinose A, Takahashi W, et al. Comparison of the effects of various anticholinergic drugs on human isolated urinary bladder. Arch Int Pharmacodyn Ther. 1995. 330:76–89.