-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Introduction Children with overactive bladder (POAB) is a common lower urinary tract dysfunction syndrome
.
The 2018 and 2020 epidemiological surveys showed that the prevalence of OAB in Chinese children aged 5-14 years and adolescent females aged 17-21 was 9.
01% and 6.
1%, respectively
.
The incidence of nocturnal enuresis, constipation, and fecal incontinence in children with OAB was significantly higher than that in healthy groups.
The incidence of frequency, urgency, and incontinence in adults with a history of OAB in childhood was significantly higher
.
Definition POAB is defined as a clinical syndrome characterized by urinary urgency, often accompanied by frequent urination, nocturnal polyuria, enuresis, etc.
, with or without urge incontinence, and urinary tract infection or clear pathological factors are excluded
.
Classification From a broad perspective, POAB can be diagnosed as long as children with urinary urgency syndrome described in the OAB definition
.
According to whether there is a clear etiology, it can be divided into primary/idiopathic OAB and secondary OAB
.
The type of OAB defined by ICCS in 2016 is primary/idiopathic OAB (IOAB); and OAB with a clear etiology is called secondary OAB
.
AUA/Society of Urodynamics and Women's Urology (SUFU) guidelines define a specific type of OAB, "refractory/refractory OAB," based on the ease of treatment of OAB After treatment (8-12 weeks), the treatment fails, and one or more anti-M receptor drugs are ineffective or intolerable for 4-8 weeks
.
For children, secondary POAB can be divided into "neurogenic OAB" and "non-neurogenic OAB" according to whether it is related to neurological factors
.
In addition, on the basis of urgency, OAB can be divided into "dry OAB" and "wet OAB" according to whether there is urge incontinence or not
.
The etiology of primary OAB is not very clear, but it is currently believed that it may be related to the following abnormalities: 1) Abnormal bladder function, such as bladder instability or detrusor instability, small-capacity bladder, etc.
; 2) Urethral instability (URI) and detrusor sphincter dyssynergy (DSD); 3) hypersensitivity of the bladder, often related to bladder mucosa and hyperesthesia; 4) abnormal pelvic floor muscle function, such as weakened pelvic floor function; 5) other pathogenic factors
.
Diagnosis of urinary frequency and urgency are clinical features of OAB
.
A detailed medical history is important to diagnose OAB
.
Focus on understanding the time, frequency, frequency of urination, the amount of urine each time, and whether it is accompanied by urge incontinence
.
To avoid subjective differences in description, the diagnosis can be aided by keeping a urine diary
.
Auxiliary examinations such as routine urinalysis, urinary ultrasound, anterior and posterior sacral X-ray films, and magnetic resonance imaging (MRI) of the spinal cord can initially screen for urinary tract infections, stones, obstruction, spina bifida and other diseases
.
Free urinary flow rate (UFM) test: UFM test is simple and non-invasive, similar to the daily toilet urination process, and can initially evaluate bladder storage and voiding function
.
UFM combined with pelvic floor electromyography (EMG) examination can further confirm the existence of DSD, and the sphincter EMG activity can be detected at the same time as UFM is detected by urination
.
When UFM and PVR measurements cannot satisfy the diagnosis of OAB in children with urinary urgency symptoms, bladder pressure-volume (CMG) and pressure-flow rate (PFS) may be considered: CMG/PFS
.
Imaging Urodynamic Examination (VUDS): VUDS refers to filling the bladder with a contrast medium as a filling medium, and performing CMG/PFS under X-ray monitoring.
The shape of the bladder and urethra, the position of the bladder neck and the presence of the bladder can be observed in real time during the filling and voiding phases.
No vesicoureteral reflux (VUR),
etc.
For children with refractory/refractory OAB, direct VUDS examination is recommended to assess the status of the bladder and urethra during the filling and voiding phases from a functional and morphological perspective
.
In addition to being associated with detrusor dysfunction, OAB can also be caused by URI
.
Methods to check for URI include sphincter electromyography (EMG) and synchronized vesicourethral manometry
.
Bladder volume and bladder wall thickness index (BVWI) have been used to assess bladder detrusor instability
.
The average thickness of the bladder wall in normal children is 1.
55mm in the state of bladder filling, and the average thickness of the bladder wall after urination is 2.
76mm.
The upper limit of the thickness of the bladder wall is 3mm and 5mm, respectively.
The thickness of the bladder wall in the filling state is >3mm, which indicates that such children are urinating Increased likelihood of road damage
.
Therapeutic behavioral therapy: It is the first choice for first-line treatment of OAB, including life>
.
Drug therapy: The first-line drugs for the treatment of POAB are mainly antimuscarinic (M receptors), while β3 receptor agonists and α receptor blockers are alternatives
.
M-receptor blockers: Because the contraction of the detrusor muscle is mediated by activating cholinergic M2 and M3 receptors, antimuscarinic M drugs are widely used in the treatment of OAB
.
Oxybutynin: has a strong anti-M cholinergic effect, can relieve smooth muscle spasm, and also play a role in local anesthesia and analgesia
.
After oral administration, it can act on the detrusor of the bladder and reduce the intravesical pressure.
The recommended initial dose is 5mg/d, and the dose of the drug is increased according to the efficacy and adverse reactions.
The maximum dose is generally not more than 20mg/d
.
In the United States, the drug is widely used in the treatment of OAB and has achieved good efficacy
.
However, the drug's M receptor subtype selectivity is low, and the adverse reactions during oral administration can be manifested as dry mouth, drowsiness, blurred vision, constipation, etc.
It is not recommended for children under 5 years old
.
Tolterodine: It is a classic drug for the treatment of OAB with better effect and less adverse reactions than oxybutynin
.
The safety of medicines in children also requires a lot of data
.
Tolterodine tablets (2mg/tablet) generally take 1~2mg/d as the starting dose, generally not more than 4mg/d
.
Racemic anisodamine (654‑2): a biologically extracted M receptor blocker, once used for gastrointestinal and ureteral antispasmodic treatment of abdominal pain and urinary calculus colic, an anticholinergic drug , similar to atropine, can also be used as the treatment of OAB in children
.
Children can take 0.
1~0.
2mg/kg each time, 1~3 times a day
.
Solifenacin: As a highly selective M3 receptor blocker, it has few adverse reactions
.
It has been widely used in children abroad, and some domestic scholars have begun to use small doses for the treatment of POAB
.
The drug insert is not recommended for children, and the long-term safety of children's medication still lacks sufficient evidence-based medicine
.
Beta3 agonists: Mirabegron is a selective beta3 adrenergic agonist for the treatment of OAB
.
Mirabegron has been widely used in adult OAB at home and abroad with less adverse reactions than M-receptor blockers
.
Combination therapy with M-receptor blockers for POAB
.
Similar to solifenacin, the drug label is not recommended for children
.
Alpha-blockers: The drug used in foreign research is tamsulosin.
The conventional dose for adults is 0.
2 mg/d, but there are currently no low-dose tablets or capsules specially designed for children, and the dose may be reduced as appropriate
.
Or another alpha-blocker is terazosin, the usual dose is 0.
2 mg/kg per day, with a maximum of 0.
4 mg/kg per day
.
Common adverse drug reactions of alpha-blockers may be hypotension, syncope, and somnolence
.
Combination medication: Studies have found that oral oxybutynin 5-20mg/d or tolterodine 2-4mg/d combined with low-dose solifenacin (5-10mg/d) has a good effect in the treatment of refractory OAB in children.
It is more effective than simply increasing the dose of oxybutynin, which may be related to the high M receptor selectivity of solifenacin
.
Botulinum toxin type A injection therapy: Generally, the treatment plan of botulinum toxin type A injection should be considered for children with refractory OAB that seriously affects the quality of life or combined with upper urinary tract damage, and may suffer from increased PVR or urinary retention.
risk
.
Sacral Neuromodulation (SNM) and Electrical Sacral Nerve Stimulation and Transcutaneous Electrical Tibial Nerve Stimulation (PTNS): Although the U.
S.
Food and Drug Administration (FDA) currently only approves the use of SNM in adults to treat related conditions, SNM is currently used to improve the Problems with urination and defecation have been confirmed by several experts
.
In clinical practice, patients often refuse this therapy because of expensive pacemakers
.
In principle, behavior and drug therapy should be considered for OAB caused by non-neurogenic bladder.
For refractory OAB, it can be selected as appropriate
.
Surgical treatment: For children with severe low-compliance bladder, small bladder capacity and endanger the function of the upper urinary tract, surgery is an option for children with OAB who have failed other treatments
.
Surgical methods include autogenous bladder enlargement, intestinal cystoplasty, urinary diversion, and detrusor transection
.
Figure of the diagnosis and treatment process of overactive bladder in children Source: Pediatric Urodynamics and Pelvic Floor Group of Pediatric Surgery Branch of Chinese Medical Association, Urology Group of Pediatric Surgery Branch of Chinese Medical Association.
Chinese expert consensus on diagnosis and treatment of children with overactive bladder[ J].
Chinese Journal of Medicine, 2021, 101(40): 3278-3286.
DOI: 10.
3760/cma.
j.
cn112137-20210529-01232.
.
The 2018 and 2020 epidemiological surveys showed that the prevalence of OAB in Chinese children aged 5-14 years and adolescent females aged 17-21 was 9.
01% and 6.
1%, respectively
.
The incidence of nocturnal enuresis, constipation, and fecal incontinence in children with OAB was significantly higher than that in healthy groups.
The incidence of frequency, urgency, and incontinence in adults with a history of OAB in childhood was significantly higher
.
Definition POAB is defined as a clinical syndrome characterized by urinary urgency, often accompanied by frequent urination, nocturnal polyuria, enuresis, etc.
, with or without urge incontinence, and urinary tract infection or clear pathological factors are excluded
.
Classification From a broad perspective, POAB can be diagnosed as long as children with urinary urgency syndrome described in the OAB definition
.
According to whether there is a clear etiology, it can be divided into primary/idiopathic OAB and secondary OAB
.
The type of OAB defined by ICCS in 2016 is primary/idiopathic OAB (IOAB); and OAB with a clear etiology is called secondary OAB
.
AUA/Society of Urodynamics and Women's Urology (SUFU) guidelines define a specific type of OAB, "refractory/refractory OAB," based on the ease of treatment of OAB After treatment (8-12 weeks), the treatment fails, and one or more anti-M receptor drugs are ineffective or intolerable for 4-8 weeks
.
For children, secondary POAB can be divided into "neurogenic OAB" and "non-neurogenic OAB" according to whether it is related to neurological factors
.
In addition, on the basis of urgency, OAB can be divided into "dry OAB" and "wet OAB" according to whether there is urge incontinence or not
.
The etiology of primary OAB is not very clear, but it is currently believed that it may be related to the following abnormalities: 1) Abnormal bladder function, such as bladder instability or detrusor instability, small-capacity bladder, etc.
; 2) Urethral instability (URI) and detrusor sphincter dyssynergy (DSD); 3) hypersensitivity of the bladder, often related to bladder mucosa and hyperesthesia; 4) abnormal pelvic floor muscle function, such as weakened pelvic floor function; 5) other pathogenic factors
.
Diagnosis of urinary frequency and urgency are clinical features of OAB
.
A detailed medical history is important to diagnose OAB
.
Focus on understanding the time, frequency, frequency of urination, the amount of urine each time, and whether it is accompanied by urge incontinence
.
To avoid subjective differences in description, the diagnosis can be aided by keeping a urine diary
.
Auxiliary examinations such as routine urinalysis, urinary ultrasound, anterior and posterior sacral X-ray films, and magnetic resonance imaging (MRI) of the spinal cord can initially screen for urinary tract infections, stones, obstruction, spina bifida and other diseases
.
Free urinary flow rate (UFM) test: UFM test is simple and non-invasive, similar to the daily toilet urination process, and can initially evaluate bladder storage and voiding function
.
UFM combined with pelvic floor electromyography (EMG) examination can further confirm the existence of DSD, and the sphincter EMG activity can be detected at the same time as UFM is detected by urination
.
When UFM and PVR measurements cannot satisfy the diagnosis of OAB in children with urinary urgency symptoms, bladder pressure-volume (CMG) and pressure-flow rate (PFS) may be considered: CMG/PFS
.
Imaging Urodynamic Examination (VUDS): VUDS refers to filling the bladder with a contrast medium as a filling medium, and performing CMG/PFS under X-ray monitoring.
The shape of the bladder and urethra, the position of the bladder neck and the presence of the bladder can be observed in real time during the filling and voiding phases.
No vesicoureteral reflux (VUR),
etc.
For children with refractory/refractory OAB, direct VUDS examination is recommended to assess the status of the bladder and urethra during the filling and voiding phases from a functional and morphological perspective
.
In addition to being associated with detrusor dysfunction, OAB can also be caused by URI
.
Methods to check for URI include sphincter electromyography (EMG) and synchronized vesicourethral manometry
.
Bladder volume and bladder wall thickness index (BVWI) have been used to assess bladder detrusor instability
.
The average thickness of the bladder wall in normal children is 1.
55mm in the state of bladder filling, and the average thickness of the bladder wall after urination is 2.
76mm.
The upper limit of the thickness of the bladder wall is 3mm and 5mm, respectively.
The thickness of the bladder wall in the filling state is >3mm, which indicates that such children are urinating Increased likelihood of road damage
.
Therapeutic behavioral therapy: It is the first choice for first-line treatment of OAB, including life>
.
Drug therapy: The first-line drugs for the treatment of POAB are mainly antimuscarinic (M receptors), while β3 receptor agonists and α receptor blockers are alternatives
.
M-receptor blockers: Because the contraction of the detrusor muscle is mediated by activating cholinergic M2 and M3 receptors, antimuscarinic M drugs are widely used in the treatment of OAB
.
Oxybutynin: has a strong anti-M cholinergic effect, can relieve smooth muscle spasm, and also play a role in local anesthesia and analgesia
.
After oral administration, it can act on the detrusor of the bladder and reduce the intravesical pressure.
The recommended initial dose is 5mg/d, and the dose of the drug is increased according to the efficacy and adverse reactions.
The maximum dose is generally not more than 20mg/d
.
In the United States, the drug is widely used in the treatment of OAB and has achieved good efficacy
.
However, the drug's M receptor subtype selectivity is low, and the adverse reactions during oral administration can be manifested as dry mouth, drowsiness, blurred vision, constipation, etc.
It is not recommended for children under 5 years old
.
Tolterodine: It is a classic drug for the treatment of OAB with better effect and less adverse reactions than oxybutynin
.
The safety of medicines in children also requires a lot of data
.
Tolterodine tablets (2mg/tablet) generally take 1~2mg/d as the starting dose, generally not more than 4mg/d
.
Racemic anisodamine (654‑2): a biologically extracted M receptor blocker, once used for gastrointestinal and ureteral antispasmodic treatment of abdominal pain and urinary calculus colic, an anticholinergic drug , similar to atropine, can also be used as the treatment of OAB in children
.
Children can take 0.
1~0.
2mg/kg each time, 1~3 times a day
.
Solifenacin: As a highly selective M3 receptor blocker, it has few adverse reactions
.
It has been widely used in children abroad, and some domestic scholars have begun to use small doses for the treatment of POAB
.
The drug insert is not recommended for children, and the long-term safety of children's medication still lacks sufficient evidence-based medicine
.
Beta3 agonists: Mirabegron is a selective beta3 adrenergic agonist for the treatment of OAB
.
Mirabegron has been widely used in adult OAB at home and abroad with less adverse reactions than M-receptor blockers
.
Combination therapy with M-receptor blockers for POAB
.
Similar to solifenacin, the drug label is not recommended for children
.
Alpha-blockers: The drug used in foreign research is tamsulosin.
The conventional dose for adults is 0.
2 mg/d, but there are currently no low-dose tablets or capsules specially designed for children, and the dose may be reduced as appropriate
.
Or another alpha-blocker is terazosin, the usual dose is 0.
2 mg/kg per day, with a maximum of 0.
4 mg/kg per day
.
Common adverse drug reactions of alpha-blockers may be hypotension, syncope, and somnolence
.
Combination medication: Studies have found that oral oxybutynin 5-20mg/d or tolterodine 2-4mg/d combined with low-dose solifenacin (5-10mg/d) has a good effect in the treatment of refractory OAB in children.
It is more effective than simply increasing the dose of oxybutynin, which may be related to the high M receptor selectivity of solifenacin
.
Botulinum toxin type A injection therapy: Generally, the treatment plan of botulinum toxin type A injection should be considered for children with refractory OAB that seriously affects the quality of life or combined with upper urinary tract damage, and may suffer from increased PVR or urinary retention.
risk
.
Sacral Neuromodulation (SNM) and Electrical Sacral Nerve Stimulation and Transcutaneous Electrical Tibial Nerve Stimulation (PTNS): Although the U.
S.
Food and Drug Administration (FDA) currently only approves the use of SNM in adults to treat related conditions, SNM is currently used to improve the Problems with urination and defecation have been confirmed by several experts
.
In clinical practice, patients often refuse this therapy because of expensive pacemakers
.
In principle, behavior and drug therapy should be considered for OAB caused by non-neurogenic bladder.
For refractory OAB, it can be selected as appropriate
.
Surgical treatment: For children with severe low-compliance bladder, small bladder capacity and endanger the function of the upper urinary tract, surgery is an option for children with OAB who have failed other treatments
.
Surgical methods include autogenous bladder enlargement, intestinal cystoplasty, urinary diversion, and detrusor transection
.
Figure of the diagnosis and treatment process of overactive bladder in children Source: Pediatric Urodynamics and Pelvic Floor Group of Pediatric Surgery Branch of Chinese Medical Association, Urology Group of Pediatric Surgery Branch of Chinese Medical Association.
Chinese expert consensus on diagnosis and treatment of children with overactive bladder[ J].
Chinese Journal of Medicine, 2021, 101(40): 3278-3286.
DOI: 10.
3760/cma.
j.
cn112137-20210529-01232.
