Recent Trends and Advances in Anterior Urethroplasty.

While patient preference often helps guide treatment decisions, poor long-term success combined with cumulative risk of repeat endoscopic treatments and the complications innately associated with urethral stricture emphasize that urethroplasty is most often the best choice for successful treatment in the long-term. This has led to the need to better refine urethroplasty techniques and optimize patient outcomes. Urethroplasty has now largely transitioned to a day-surgery procedure in the majority of centers. Some evidence suggests that avoiding urethral transection and/or avoiding overzealous urethral mobilization may lead to a reduction in post-operative sexual dysfunction. The trend toward single stage penile urethroplasty with buccal mucosal grafts likely minimizes patient morbidity without compromising urethroplasty success. For urethroplasty success to further improve particularly in patients at high risk for stricture recurrence, the synergistic potential of combining wound healing enhancing agents with evolving tissue-engineering represents an exciting future opportunity in the quest to perfect urethroplasty outcomes.

First North American experience of propiverine use in children with overactive bladder.

INTRODUCTION: In 2017, propiverine was approved in Canada for overactive bladder (OAB) in adults and children. There is, however, scarce data on its efficacy and tolerability in the pediatric population. Our primary objective was to assess the efficacy and tolerability of propiverine as a treatment for pediatric OAB. Our secondary objective was to compare propiverine to molecules already investigated in historical cohorts. METHODS: We conducted a retrospective analysis of a prospectively maintained database and reviewed 58 patients who received propiverine since 2017. Efficacy and tolerability were assessed through voiding diaries, postvoid residuals (PVR), changes in the number of incontinence and urgency episodes (grade 1 to 3), and on reported adverse events. RESULTS: In total, 58 patients (37 boys) initiated treatment at a mean age of 9.5±3.2 years. Patients were on propiverine for an average of 15.9±12.4 months. Mean bladder capacity increased from 120 ml to 216 ml, and % expected bladder capacity (%EBC) increased from 37% to 59%. The average increased rate of %EBC was 0.5% per month (p<0.001). Of the 58 patients, eight stopped the medication completely without symptom recurrence, 21 were still on medication, and six were on dose-tapering. Due to side effects, seven interrupted their treatment. Compared to molecules used in our service, propiverine offered comparable efficacy and tolerability. Our study had limitations, including the absence of a placebo group and its retrospective design. CONCLUSIONS: Propiverine appears to be an efficient and safe option for treating OAB in children and is approved as such.

A randomized, crossover trial comparing the efficacy and safety of fesoterodine and extended-release oxybutynin in children with overactive bladder with 12-month extension on fesoterodine: The FOXY study.

INTRODUCTION: We sought to assess and compare safety and efficacy of fesoterodine and oxybutynin extended-release in the treatment of pediatric overactive bladder (OAB). METHODS: We conducted a non-inferiority, randomized, double-blind, crossover trial comparing fesoterodine 4-8 mg and oxybutynin 10-20 mg once daily (QD) in children with OAB aged 5-14 years (2015-2018). Every child received the first medication for eight weeks, followed by crossover to the second antimuscarinic after a three-days washout. Dose up-titration was possible at mid-course. Patients could enter a fesoterodine 12-month extension. Endpoints were assessed through changes on voiding diaries, Patient's Perception of Bladder Condition score (PPBC), adverse events, vital signs, electrocardiogram, post-void residual, urinalysis, and blood tests. The Wilcoxon rank sum and Wilcoxon signed rank tests were used for statistical analysis. RESULTS: A total of 62 patients were randomized (two early dropouts). Expected class effects (dry mouth/constipation) were present but no significant difference was observed. There was a 10.1 beats/minute increase in heart rate with fesoterodine (p<0.01) (oxybutynin-1.9 beats/min; p=non-significant [ns]). No life-threatening or serious adverse events occurred. Efficacy was similar for both drugs. Bladder capacity improved over the 16 months of the study; baseline capacity of 125 mL (44.5% expected bladder capacity for age [%EBC]) to 171 mL (53.9 %EBC) at the end of the extension phase. No clinical or statistical difference was shown between efficacy measures for fesoterodine or oxybutynin. CONCLUSIONS: The use of fesoterodine or oxybutynin appear safe and effective for the treatment of OAB in children. Based on our study, long-term treatment to achieve the ultimate goal of urinary continence is needed in this population.