Introduction: Antimuscarinics are the cornerstone of the pharmacological treatment of overactive bladder (OAB) but side effects often limit their long-term use. Propiverine hydrochloride, a molecule with a mixed mechanism of action, was approved in Canada in 2017 as a therapy for OAB in adults and children. However, there is scarce data on its efficacy and tolerability in the pediatric population. Our primary objective was to assess the efficacy and tolerability of propiverine as a first- or second-line pharmacological treatment of OAB in children. Our secondary objective was to compare propiverine to other molecules already investigated in historical cohorts.

Methods: We conducted a retrospective analysis of a prospectively maintained database and reviewed 58 patients who received propiverine between 2017 and 2021. Patients had to attend at least one followup visit to be included. Efficacy and tolerability were assessed through voiding diaries, postvoid residuals (PVR), and by questioning patients and families on change in the number of incontinence episodes (day and night), in urgency episodes (grade 1–3), and on reported adverse events. Categorical variables were reported as counts and percentages, and descriptive statistics (mean and standard deviation or medians and quartiles) were reported for continuous variables. Paired tests were used to assess the evolution of mean bladder capacity and expected bladder capacity (%EBC) scores at different followup points, and linear regression models with the GEE method were used to estimate their average monthly variation.

Results: Fifty-eight patients (37 boys) initiated treatment at a mean age of 9.5±3.2 years. Patients were on propiverine for an average of 15.9±12.4 months. Mean bladder capacity increased from 120 ml to 216 ml, and %EBC increased from 37% to 59%. The average increased rate of %EBC was 0.5% per month (p<0.001). Of the 58 patients, eight were able to stop the medication completely without symptom recurrence, 21 are still on medication, and six are on dose-tapering. Due to treatment-related adverse events, seven interrupted their treatment. Compared to other molecules regularly used in our service, propiverine offered comparable efficacy and tolerability. Our study had limitations: the absence of a placebo group and its retrospective design.

Conclusions: Propiverine appears to be an efficient and safe option for treating OAB in children and is approved for use in children.