Effect of propiverine hydrochloride on stress urinary incontinence

Abstract

Abbreviations & AcronymsObjectives: To investigate whether the anticholinergic agent, propiverine hydrochloride, is clinically effective for stress urinary incontinence. Methods: The participants were adult female patients with the chief complaint of stress incontinence. Propiverine (20 mg once daily) was given for 8 weeks. If the response was inadequate after 4 weeks of treatment, the dose was increased to 40 mg/day. Before and after 4 and 8 weeks of treatment, lower urinary tract symptoms were assessed. The urethral pressure and blood catecholamine levels were also measured. Results: A total of 37 patients (mean age 69 ± 11 years) were enrolled, including 15 patients with stress incontinence and 22 with mixed incontinence. The number of episodes of stress incontinence decreased significantly from 2.6 ± 2.3 times per day to 1.3 ± 2.2 times per day after 4 weeks, and 0.4 ± 0.6 times per day after 8 weeks. The daytime and night-time frequency of urination, and quality of life score showed significant improvement. The maximum urethral closing pressure and the functional urethral length increased significantly after treatment, but blood catecholamine levels, blood pressure and pulse rate at 8 weeks were not significantly different from those at baseline. Conclusions: Propiverine could be an effective drug for stress urinary incontinence by increasing urethral closing pressure without increasing blood catecholamine levels.

Editorial Comment from Dr Negoro to Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats

“…These findings were consistent with their previous report that propiverine supplementation (5 mg/mL/day for 2 weeks) increased the urethral baseline pressure, whereas imidafenacin (an anticholinergic agent, 0.01 mg/mL/day) did not show such an increased response. 5 Regarding the mechanism and site of action of propiverine based on the current and previous results, it is conceivable that an increase of noradrenaline induced by propiverine can activate both sympathetic pathways and Onuf's nucleus through a1-adrenergic receptors to increase the urethral baseline pressure and LPP. These mechanisms might be reasonable to ameliorate SUI, and propiverine could be a promising tool for the treatment of SUI.…”

“…4 Interestingly, previous manuscripts have reported the efficacy of propiverine, an anticholinergic drug with calcium antagonistic action, against pure SUI patients in Japan. 5 In the present study, Nishijima et al tried to investigate the mechanism through which propiverine is effective for treating SUI. 6 The authors found that intravenous injection of propiverine increased the leak point pressure in rats with vaginal distention.…”

“…It would be expected that differences between young and old subjects in addition to those of different species would be evaluated, as various effects of propiverine have been reported in different conditions. [3][4][5] Further research will help to answer whether the administration of a physiological dose of propiverine in elderly patients actually has an inhibitory effect of noradrenalin re-uptake and increases catecholamine in the urethral wall.…”

Efficacy and Safety of Propiverine Chloride Flexible Dose in Female Mixed Urinary Incontinence Patients

“…Propiverine hydrochloride (referred to in the following as propiverine) has been shown to combine both anticholinergic and calcium channel blocking actions and reported to be effective for the treatment of stress incontinence as well as detrusor overactivity [5]. In daily practice, propiverine, an anticholinergic drug indicated for urge incontinence, is given to patients who have both urge incontinence and stress incontinence [5].…”

“…In daily practice, propiverine, an anticholinergic drug indicated for urge incontinence, is given to patients who have both urge incontinence and stress incontinence [5].…”