Successful treatment of overactive bladder in a child with myasthenia gravis.

Detrusor overactivity in patients with congenital myasthenia gravis is a rare finding. Owing to the underlying disease, anticholinergic treatment is not possible. We present the case of a 6-year-old child in whom a significant improvement was achieved by means of functional electrical stimulation.

Efficacy, tolerability and safety of propiverine hydrochloride in children and adolescents with congenital or traumatic neurogenic detrusor overactivity--a retrospective study.

OBJECTIVES: Anticholinergic treatment combined with intermittent catheterisation is the cornerstone of the conservative treatment strategy in children with neurogenic detrusor overactivity, which in most cases is due to congenital causes. Efficacy, tolerability and safety of propiverine hydrochloride were evaluated retrospectively in these children. METHODS: At four specialized outpatient clinics, all children's records were scrutinized for first-line propiverine hydrochloride treatment, or second- or third-line treatment after failure of a non-selective alpha-blocker (phenoxybenzamine) and/or other anticholinergics (oxybutynin, trospium chloride). The primary efficacy outcomes were urodynamic parameters, with clinical symptoms as secondary outcomes. Statistical analysis was performed by paired t-tests (significance level p < 0.05). RESULTS: Altogether 74 children and adolescents (40 boys, 34 girls; age range 11 months-19 years) were treated with propiverine hydrochloride (average duration 2 years and approximately 4 months; individual dose range 5-75 mg). The primary efficacy outcome parameters improved significantly: maximum cystometric capacity 161.2 [standard deviation (SD) 97.3] to 252.2 ml (SD 117.2), p < 0.001; maximum detrusor pressure 43.8 (SD 39.2) to 27.1 cm H(2)O (SD 26.4), p = 0.002; bladder compliance 7.6 (SD 6.4) to 17.0 ml/cm H(2)O (SD 16.2), p < 0.001. Phasic detrusor overactivity was abolished by 63%; incontinence resolved by 54%. One patient spontaneously reported a typical anticholinergic adverse event, which resolved after dose reduction. No safety concerns were documented. CONCLUSIONS: Propiverine hydrochloride is effective in neurogenic detrusor overactivity in children and adolescents, even in some of those cases unresponsive to other anticholinergics. The low incidence rate (<1.5%) of adverse events evidences a favourable risk-benefit profile of propiverine hydrochloride, considering in particular the total documented treatment and surveillance period of 171 patient years and nine months.

Bacterial contamination of test stimulation leads during percutaneous nerve stimulation.

OBJECTIVES: To analyze the bacterial contamination of conventional percutaneous nerve stimulation (PNE) leads. Sacral neuromodulation has become an important tool for the treatment of urgency and chronic retention. Patients likely to benefit from this type of therapy are identified by PNE testing before implantation of the definitive system. Recently, a new system was introduced, using a self-blocking electrode that remains in place for both PNE testing and final implantation. PNE testing warrants an extracorporeal stimulator. Thus, using the same electrode for both external stimulation and definitive implantation may carry a significant risk of infection. METHODS: Bilateral PNE testing was performed in 11 consecutive patients (8 women and 3 men, mean age 41.6 years) for either urgency (n = 7) or chronic retention (n = 4). Electrodes were placed under aseptic conditions and stimulated for 3 days. At the end of each test, the electrodes were removed and evaluated microbiologically. RESULTS: In 5 of the 11 patients (9 of 22 leads), significant bacterial growth was detected: Staphylococcus epidermidis in 5, Escherichia coli in 3, and Enterococcus faecalis in 1. However, no patient showed signs of inflammation at the electrode insertion sites. CONCLUSIONS: Bacterial growth was found in 45.5% of the patients after conventional PNE testing under aseptic conditions. Therefore, the new electrodes may well carry an elevated risk of infection. Infection of the implant can lead to major surgical revision or even explantation. Thus, additional studies of the infection risk of this new electrode are warranted before its general use can be recommended.