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An empirical treatment algorithm for incontinent children
Arne-Daniela Marschall-Kehrel1, Gerd Mürtz, Guus Kramer
1Urology Consultancy, Oberursel, Apogepha Arzneimittel GmbH, Dresden, Germany. kehrel.daniela@t-online.de
Insights
Propiverine monotherapy is effective for treating urge incontinence in children. Adjuvant therapies significantly increase continence rates in partial responders, reducing the need for specialized management.
Area of Science:
- Pediatric Urology
- Continence Management
Background:
- Monotherapy for pediatric urge incontinence has limited success rates.
- Adjuvant treatment strategies may improve outcomes in children with incontinence.
Purpose of the Study:
- To evaluate the efficacy of adjuvant treatment in children with urge incontinence.
- To assess if adjuvant therapies improve continence and functional bladder capacity.
Main Methods:
- Children with incontinence received propiverine (0.4 mg/kg) twice daily for 4 weeks.
- Partial responders underwent a second treatment period of 12 weeks with adjuvant therapies.
- Adjuvant treatments included alpha-blockers, desmopressin, or biofeedback.
Main Results:
- 29 out of 70 children achieved continence with initial propiverine therapy.
- 35 partial responders received adjuvant treatment, with 20 achieving continence.
- Overall efficacy was enhanced by combining propiverine with adjuvant modalities.
Conclusions:
- Propiverine monotherapy is an effective treatment for pediatric urge incontinence.
- Adjuvant treatment significantly improves overall efficacy in partial responders.
- This combined approach reduces the need for specialized management in children.
Purpose:
Successful response rates of monotherapeutic strategies in urge incontinent children are limited. We evaluate whether adjuvant treatment improves outcomes.
Materials And Methods:
Incontinent children were evaluated according to International Consultation on Incontinence standards. Propiverine (0.4 mg/kg) was applied 2 times daily for 4 weeks (treatment period 1) before reevaluation. Primary outcome was achievement of continence and secondary outcome was improvement of functional bladder capacity. In partial responders an alternative adjuvant treatment was initiated for another 12 weeks (treatment period 2).
Results:
Of 70 enrolled patients 29 achieved continence (responders) and 35 responded partially and were assigned to adjuvant treatment, which consisted of selective alpha-blocker for functional bladder outflow obstruction (6), desmopressin for excessive nocturnal urine production (19) and biofeedback for increased pelvic floor activity during micturition (10). Only 6 nonresponders (9%) were assigned to specialized management. After treatment 2, 20 of the 35 partial responders achieved continence, thus avoiding specialized management.
Conclusions:
Propiverine monotherapy for incontinent children is effective. However, applying adjuvant treatment modalities to partial responders increases overall efficacy rates.
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