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Continence training of children with neurogenic bladder and detrusor hyperactivity: effect of atropine
Insights
Anticholinergic medications effectively treat urinary incontinence in children with myelodysplasia by inhibiting detrusor hyperactivity. Careful patient selection, including intravesical pressure monitoring, is crucial for successful treatment outcomes.
Area of Science:
- Pediatric Urology
- Neurology
- Pharmacology
Background:
- Myelodysplasia, a congenital condition, often leads to neurogenic bladder dysfunction, characterized by detrusor hyperactivity.
- Urinary incontinence is a significant challenge in managing children with myelodysplasia, impacting their quality of life.
- Anticholinergic medications are a cornerstone in managing bladder overactivity.
Purpose of the Study:
- To investigate the efficacy of anticholinergic medication in managing detrusor hyperactivity in children with myelodysplasia.
- To assess the dose-dependent effects of anticholinergic drugs on intravesical pressure during the filling phase.
- To evaluate the effectiveness of atropine, administered parenterally and orally, for treating urinary incontinence.
Main Methods:
- Intravesical pressure was recorded during the filling phase in children with myelodysplasia.
- Detrusor hyperactivity was identified and its inhibition by anticholinergic medication was studied under experimental conditions.
- Atropine efficacy was evaluated following parenteral and oral administration in patients experiencing urinary incontinence.
Main Results:
- Detrusor hyperactivity was observed in children with myelodysplasia, which was inhibited by anticholinergic medication in a dose-dependent manner.
- Parenteral atropine demonstrated remarkable effectiveness in treating urinary incontinence during daily activities.
- Oral atropine resulted in significant improvement (50-100%) in six of nine patients and moderate improvement (35-45%) in the remaining three.
Conclusions:
- Anticholinergic drugs are effective in managing detrusor hyperactivity and urinary incontinence in children with myelodysplasia.
- Successful treatment necessitates careful patient selection based on intravesical pressure recordings, identifying those with detrusor hyperactivity.
- Atropine, particularly when administered parenterally, offers a viable therapeutic option for improving incontinence in this pediatric population.
Abstract:
Recording of the intravesical pressure throughout the filling phase in children with low lumbar and high sacral levels of myelodysplasia showed detrusor hyperactivity which could be inhibited by anticholinergic medication in a dose-dependent manner under experimental conditions. Atropine as treatment for urinary incontinence during everyday activity was remarkably effective when given parenterally. Orally administered atropine was associated with 50-100% improvement of incontinence in six of 9 patients and 35-45% in the remaining three patients. Successful treatment with anticholinergic drugs requires careful selection of patients, including recording of the filling-phase intravesical pressure. Only in patients with detrusor hyperactivity is a good result of such treatment to be expected.