Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector77910.17816/ps779Original Study ArticlesОригинальные исследованияResearch ArticlePredictors of the effectiveness of initial therapy with antimuscarinic agents in children with neurogenic urination disordersПредикторы эффективности стартовой терапии М-холиноблокаторами у детей с нейрогенными нарушениями мочеиспусканияhttps://orcid.org/0009-0000-2669-3413ShabaevSergey A.ШабаевСергей Александрович
Russian Federation

MD

pancef@icloud.comhttps://orcid.org/0000-0002-1940-13958779-8960MorozovDmitry A.МорозовДмитрий Анатольевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

damorozov@list.ruhttps://orcid.org/0000-0001-9850-67794284-4702AfukovIvan I.АфуковИван Игоревич
Russian Federation

MD, Cand. Sci. (Medicine), Associate Professor

канд. мед. наук, доцент

dgkb9@zdrav.mos.ruhttps://orcid.org/0000-0002-3718-89116989-5041RostovskayaVera V.РостовскаяВера Васильевна
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

rostovskaya_vera@mail.ruI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый МГМУ имени И.М. Сеченова Минздрава России (Сеченовский Университет)G.N. Speransky Children's City Clinical Hospital No 9Детская городская клиническая больница № 9 имени Г.Н. Сперанского01072024130720242832642752001202407022024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://jps-nmp.ru/jour/article/view/779

BACKGROUND: Almost a third of patients with neurogenic urinary disorders have a refractory nature to therapy with antimuscarinic agents. The aim of the current trial was to identify predictors of the effectiveness of initial therapy with antimuscarinic agents in children with neurogenic urination disorders. For this, a comprehensive analysis of clinical parameters and video urodynamic findings in children was made.

AIM: The purpose of this study was to identify predictors of the successful initial therapy with M-anticholinergic preparations in children with neurogenic urinary disorders. For this, results of a comprehensive analysis of initial clinical and video urodynamic parameters were used..

METHODS: A prospective longitudinal cohort study involved 62 patients, aged 1.8–18 years, with neurogenic urination. In addition to the standard examination, all patients underwent a video urodynamic examination at Laborite Delphis UDS-600 device with parallel cystography at Siemens X-ray C-arc (Siemens, Germany). By the obtained results, 52 out of 62 patients were prescribed antimuscarinic agents as the first line therapy. Therapy effectiveness was assessed in 3 months. Analysed parameters were age, presence/absence of self-catheterization, as well as presence/absence of vesicoureteral reflux (VUR) revealed at conventional retrograde urethrocystography and/or video urodynamic examination.

RESULTS: The multivariate regression analysis demonstrated that the risk of ineffective antimuscarinic therapy increases by 75,6% in patients with VUR revealed at retrograde uretrocystography, regardless of patient's age and 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 VUR is detected at video urodynamic examination. Unlike patients with a positive effect (n=24; 50%), 24 patients (50%) who had no response to antimuscarinic therapy were younger (median age 8 years); they also were self-catheterized and had VUR revealed at video urodynamic examination. Outcomes of the prescribed therapy were not associated with other video urodynamic parameters. The identified significant predictors (age, self-catheterization and VUR at video urodynamic examination) have allowed to develop a model for predicting antimuscarinic therapy effectiveness before its administration. This model can promote a rational selection of patients for antimuscarinic therapy, as the first line therapy, with a high probability of positive outcome in 84.9% of patients.

CONCLUSION: When prescribing antimuscarinic agents, patient's age, self-catheterization, VUR revealed at retrograde urethrocystography and video urodynamic examination should be taken into account. Predictors of effective antimuscarinic therapy in children with neurogenic urinary disorders, which increase the likelihood of successful outcomes, are patient's age (over 12 years), no self-catheterization and no VUR at video urodynamic examination. Patients younger than 12 years, with self-catheterization and VUR are less likely to respond to antimuscarinic therapy.

Обоснование. Почти у трети больных с нейрогенными нарушениями мочеиспускания отмечается рефрактерность к терапии антихолинергическими препаратами. Целью настоящей работы стало выявление предикторов успеха эффективности стартовой терапии М-холиноблокаторами (МХБ) у детей с нейрогенными нарушениями мочеиспускания на основе комплексного анализа результатов клинического и видео-уродинамического обследования.

Цель. Выявление предикторов успеха эффективности стартовой терапии МХБ у детей с нейрогенными нарушениями мочеиспускания на основе комплексного анализа исходных результатов клинического и видео-уродинамического обследования.

Методы. В исследовании участвовали 62 пациента в возрасте от 1,8 до 18 лет (медиана 9,5 лет) с верифицированными нейрогенными нарушениями мочеиспускания. Все пациенты, помимо стандартного обследования, прошли видео- уродинамическое исследование (ВУДИ). По результатам обследования, 52 пациентам в качестве первой линии терапии были назначены МХБ. Результаты лечения проанализированы через 12 нед. с учётом возраста, факта самокатетеризации, наличия пузырно-мочеточникового рефлюкса (ПМР) по данным ретроградной уретроцистографии и/или ВУДИ.

Результаты. По результатам многофакторного регрессионного анализа шанс неэффективности терапии МХБ увеличивался на 75,6% при наличии ПМР на ретроградной цистографии независимо от возраста и необходимости самокатетеризации (отношение шансов 0,244; 95% доверительный интервал 0,063–0,937; р=0,04) и на 89,8% (отношение шансов 0,102; 95% доверительный интервал 0,019–0,554; р=0,008) при выявлении ПМР по результатам ВУДИ. В отличие от пациентов с положительным эффектом (n=24; 50%), 24 (50%) пациента без ответа на терапию МХБ были моложе (медианный возраст 8 лет), находились на самокатетеризации и имели ПМР по результатам ВУДИ. Результат лечения не был связан с другими параметрами ВУДИ. На основании выделенных значимых предикторов разработана модель прогнозирования эффективности МХБ до начала лечения, которая позволяет с высокой долей вероятности (84,9%) осуществить рациональный отбор пациентов для терапии антихолинергическими препаратами в качестве первой линии.

Заключение. При назначении МХБ следует учитывать возраст пациента, факт самокатетеризации, наличие ПМР по данным ретроградной уретроцистографии или ВУДИ. К предикторам эффективности применения МХБ у детей с нейрогенными нарушениями мочеиспускания, повышающим вероятность успешного ответа на терапию, могут быть отнесены возраст пациента (старше 12 лет), отсутствие необходимости самокатетеризации и наличие ПМР по результатам ВУДИ. Пациенты младше 12 лет, нуждающиеся в самокатетеризации и имеющие ПМР имеют меньше шансов на эффективность антимускариновой терапии.

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