Introduction: Almost a third of patients with neurogenic urinary disorders have a refractory nature to therapy with antimuscarinic agents. The aim of current study was identification of predictors of the effectiveness of initial therapy with antimuscarinic agents in children with neurogenic urination disorders based on a comprehensive analysis of clinical and video urodynamic parameters of the examination of children.
Materials and methods. A prospective longitudinal cohort study involving 62 patients aged 1.8 to 18 years with neurogenic urination. In addition to the standard examination, all patients underwent a video urodynamic examination on a Laborite Delphis UDS-600 device with parallel cystography using a Siemens X-ray C-arc (Siemens, Germany). According to the results of the examination, 52 out of 62 patients were prescribed antimuscarinic agents as the first line of therapy. The effectiveness of therapy was evaluated after 3 months. The results of treatment were analyzed taking into account age, the presence/absence of self-catheterization, as well as the presence/absence of vesicoureteral reflux (VUR) according to conventional retrograde urethrocystography and/or video urodynamic examination.
Results. According to the results of multivariate regression analysis, the chance of ineffectiveness of antimuscarinic therapy increased by 75,6% in the presence of VUR on retrograde uretrocystography, regardless of age and the need for self-catheterization (OR=0.244; 95%CI=0.063-0.937; p=0.040) and by 89.8% (OR=0.102; 95%CI=0.019-0.554; p=0.008) when detecting VUR in video urodynamic examination. Unlike patients with a positive effect (n=24; 50%), 24 patients (50%) with no response to antimuscarinic therapy were younger (median age 8 years), were on self-catheterization and had VUR according to video urodynamic examination results. The result of the treatment was not related to other video urodynamic parameters. Based on the identified significant predictors (age, the fact of self-catheterization and the presence of VUR according to video urodynamic examination results), a model for predicting the effectiveness of antimuscarinic therapy before their appointment has been developed, which allows with a high probability (84.9%) to carry out a rational selection of patients for therapy with antimuscarinic agents as the first line.
Conclusion. When prescribing antimuscarinic agents, the patient's age, the fact of self-catheterization, the presence of VUR according to retrograde urethrocystography and video urodynamic examination should be taken into account. Predictors of the effectiveness of antimuscarinic agents in children with neurogenic urinary disorders, which increase the likelihood of a successful response to therapy, may include the age of the patient (over 12 years old), the absence of the need for self-catheterization and the presence of VUR in video urodynamic examination. Patients with self-catheterization, the presence of VUR and younger age are less likely to respond to antimuscarinic therapy.
