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S21-7
(PP)
COMBINED LOW DOSED ANTIMUSCARINICS FOR REFRACTORY DETRUSOR
OVERACTIVITY IN CHILDREN
Ahmed FAHMY
1
, Ibrahim ALHENAWY
2
, Shafik SHOUKRY
2
and Mohamed YOUSSIF
2
1) Faculty of medicine, Alexandria University, Urology department, Alexandria, EGYPT - 2) Alexandria University,
Urology department, Alexandria, EGYPT
PURPOSE
Primary goal in treatment of detrusor overactivity (DO) is to achieve a low pressure reservoir to protect upper urinary
tract and renal function. Anticholinergic agents are recommended as first line treatment for achieving this goal. We
report the results of combined use of low dose antimuscarinics in DO refractory to high dosage of a single drug in
children.
MATERIAL AND METHODS
Seventy two children with DO were enrolled after sub-optimal results with maximal dosage of monotherapy. Mean age
was 9.2 ± 4.5 years. All patients demonstrated DO at bladder diary and urodynamic and started on oxybutynin and
trospium chloride at lowest weight adjusted dose (5-10 mg / day for oxybutinine and 20-40 / day for trospium chloride).
Bladder diary on the basis of 3 days was recorded and urodynamic was repeated at 3 and 6 months.
RESULTS
Sixteen children become dry. 33 patients attained a significant decrease of incontinence from an average of 5 to 1
episode per day. Mean bladder capacity at bladder diary increased with combined treatment of 95 ml from the value
with monotherapy. Cystometeric capacity increased from 122 ± 59 ml to 246 ± 85 ml and maximal pressure
contractions decreased from 56± 16 cmH2O to 28 ± 14 cmH2O (p<0.001). Overall success rate was 68 %, since 23
patients discontinued treatment for suboptimal response or intolerable side effects.
No side effects were reported by 41 patients, mild side effects by 25, moderate side effects by 6; two patients withdrew
from the study due to their side effects.
CONCLUSIONS
A combination of antimuscarinic agents at low dosage is an effective and safe treatment approach in children with DO
who are refractory to high dosage monotherapy. Different combinations with different antimuscarinics drugs could be
evaluated in the future.