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Detrusor instability in children with recurrent urinary tract infection and/or enuresis. II. Treatment
Insights
Recurrent urinary tract infections (UTIs) and enuresis in children are often linked to detrusor instability (DI). Treatment with emepronium bromide and antibiotics effectively resolved symptoms in most cases.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Urodynamics
Background:
- Recurrent urinary tract infections (UTIs) and enuresis are common pediatric urological issues.
- Detrusor instability (DI) is a potential underlying cause contributing to these symptoms.
Purpose of the Study:
- To investigate the prevalence of detrusor instability in children with recurrent UTIs and/or enuresis.
- To evaluate the efficacy of emepronium bromide and prophylactic antibiotics in treating these conditions.
Main Methods:
- CO2 cystometry was performed on 41 children aged 5-15 years.
- Children with significant DI and urge incontinence were treated with emepronium bromide (400-600 mg daily) for 3 months.
- Some patients received adjunctive prophylactic antibiotics for frequent UTIs.
Main Results:
- 44% of referred children exhibited detrusor instability.
- 11 children with DI and urge incontinence showed symptom resolution after 3 months of emepronium bromide treatment.
- Overall symptom freedom was observed in all treated children at 6-month follow-up.
Conclusions:
- Detrusor instability is a significant factor in pediatric recurrent UTIs and enuresis.
- Emepronium bromide, often combined with prophylactic antibiotics, offers an effective treatment strategy.
- Prompt diagnosis and targeted treatment lead to positive clinical outcomes in affected children.
Abstract:
Of 41 children, aged 5-15 years, referred consecutively because of recurrent urinary tract infections (UTIs) and/or enuresis, 18 (44%) showed detrusor instability (DI) in at least 2 of 6 CO2 cystometries. One child was excluded from the study because of lack of follow-up. Four children with less pronounced DI (instability during less than or equal to 50% of the cystometries performed) and frequent UTIs were given antibiotics prophylactically for 3 months. In the remaining 13 children, DI was found during more than half the cystometries performed, and 11 of these children, who also had urge incontinence, were treated with emepronium bromide, 400-600 mg daily (10-12 mg/kg) for 3 months. In 7 of the patients this treatment was supplemented by antibiotics prophylactically because of frequent UTIs. Two children with special problems received other types of treatment. All children were free from symptoms at a clinical check-up 6 months later, 95% confidence limits 0-20%.