신경인성방광환자의 빈뇨·요실금에 대한 Propiverine HCl의 임상 효과

Abstract

Purpose: Patients with neurogenic bladder ultimately undergo morphometric and functional changes of their bladder and urethra. As a result, voiding symptoms such as frequency, nocturia, urgency and incontinence appear. Propiverine hydrochloride (BUP-4) is a benzylic acid derivative with musculotropic antispamodic activity and moderate anticholinergic effect. We evaluated the clinical and urodynamic effects of BUP-4 for patients with neurogenic urinary frequency and incontinence. Materials and Methods: Twenty six patients with neurogenic bladder suffering from urinary frequency and incontinence (including 5 placebo) were given 20mg of BUP-4 orally a day and its clinical and urodynamic effect were evaluated. Results: In the group treated with BUP-4 for four weeks, 57.9% in 19 patients with frequency, 53.3% in 15 nocturia, 50.0% in 14 weak stream, 55.6% in 9 intermittency, 50.0% in 10 dribbling, 64.3% in 14 urgency, 55.6% in 9 hesitancy, 73.7% in 19 incontinence showed improvement of their symptom. Urodynamic study performed after treatment with BUP-4 for 4 weeks or more revealed greater than 10% increase in bladder capacity compared to pretreatment study in 11 patients out of 21(52.4%) and their maximum bladder capacity increased significantly from 181.7±101.3 to 249.4±184.7mL(p=0.012). Maximum detrusor pressure decreased from 62.5±35.6 to 50.9±26.8cmH2O(p=0.010). Changes in compliance and volume on the first urge sense were statistically insignificant. In placebo group, no significant symptomatic and urodynamic improvement were reported. Side effects of the drug had appeared in 7 patients (33.3%) out of 21 after 4 weeks of treatment - 5 cases of dry mouth and 2 cases of nausea - but they were not severe enough to stop the treatment. Conclusions: The use of BUP-4 in patients with neurogenic bladder results in improvement of symptoms and urodynamic profile (bladder capacity and maximum detrusor pressure). Thus, BUP-4 could be used as one of the first line drugs in the treatment of patients with neurogenic bladder.