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The role of imipramine therapy in bladder exstrophy after bladder neck reconstruction
S Dave1, V P Grover, S Agarwala
1The Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Imipramine therapy improved continence in children with bladder exstrophy after surgery. The drug enhanced bladder capacity and reduced involuntary contractions, with minimal side effects.
Area of Science:
- Pediatric Urology
- Pharmacological Interventions
- Bladder Exstrophy Management
Background:
- Bladder exstrophy requires complex surgical reconstruction.
- Achieving complete continence post-reconstruction remains a challenge for many patients.
Purpose of the Study:
- To evaluate the efficacy of imipramine in improving urinary continence in children with bladder exstrophy post-bladder neck reconstruction.
Main Methods:
- A cohort of 17 children with bladder exstrophy and partial continence post-reconstruction received imipramine.
- Treatment involved 1.5-2 mg/kg body weight for a mean of 9.5 months.
- Continence status and urodynamic parameters were assessed before and after therapy.
Main Results:
- Eleven of 17 patients showed improved continence, with longer daytime and nocturnal continence periods.
- Significant urodynamic improvements included increased bladder capacity, higher end-fill pressure, and reduced uninhibited contractions.
- Imipramine was well-tolerated with only minor side effects reported.
Conclusions:
- Imipramine is a valuable therapeutic option for patients with bladder exstrophy who achieve partial continence after reconstruction.
- It is particularly beneficial for those with small bladder capacity, poor compliance, and uninhibited bladder contractions.
Objective:
To assess the role of imipramine therapy after bladder neck reconstruction in patients with bladder exstrophy.
Patients And Methods:
Seventeen children with bladder exstrophy who achieved partial continence after bladder neck reconstruction received imipramine (1.5-2 mg/kg body weight) for a mean duration of 9.5 months. Assessment before and after therapy included an objective classification of the continence status and artificial slow-fill cystometry.
Results:
Eleven of the 17 patients had a good clinical response to imipramine, with an increase in the continent period to > 2 h, and in nocturnal continence. The urodynamic findings showed a significant improvement in the capacity, end-fill pressure, uninhibited contractions and '20 below' capacity. Only minor side-effects of the drug were reported.
Conclusion:
Imipramine has a role in patients who achieve partial continence after reconstruction, and who have a moderately small capacity bladder with poor compliance and uninhibited contractions.