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My daughter is 11 years old and has urge urinary incontinence since birth (we realised it when she was 6 and still wetting before reaching toilet)
We did all investigations viz- MRI, Urodynamics, Sonography etc.
Reports say the following
Her prevoid volume is 60 ccs. No significant post void residue.
Pressure flow study was done in sitting position with 2 plastic catheters, fill speed 20mls/min. There was random residue of 110mls on catheterisation.
Filling phase reveals a reduced capacity bladderwith over active contractions from bladdervolume of 145mls, with urge leak. In fact she leaked about 80mls with her last contractionand finally voiding was with over active contraction showing normal flowmetry and mildly raised P det.
this is likely to be idiopathic detrusor over activity considering the preentation since childhood.However MRI spine scan will rule out any other cause.EMG is synergic.
Main result: These tests reveal satisfactory flow, no residue and a reduced capacity bladder with detrusor overactivity and urge leak as above. Compliance and proprioception are normal and EMG is synergic.
She was on Tropan(Oxybutanin) 5mg for over a year and responded well during day time. Her night time wetting was still there.
We stopped it and after a few weeks she was back to the same problem.
Then she was on Tropan 5mg again for a few months regularly and following it whenever she was having holidays we used to skip the medicine.
Then again we totally discontinued it for about a year and she was managing ok wetting once ina while . But this year in March we realised that she was having the same problem again. So this time on the advice from another Paedeatric Urologist she was given Terol LA 2mg(Tolterodine Tartrate IP). She did not respond to it and was given Terol 4mg , to which she responded well (similar to Tropan)
Kindly advice what would be the best treatment option for her as these medicines help temporarily, once stopped the problem is back.
We have also hired a physical trainer since the past 2 months to strengthen her muscles. He says generally her core muscles appear to be weak.
Also wanted to know
* if her bladder is weak / overactive or
* is there some signalling from brain that is going wrong or
* can it be that her exterior sphincter muscle, which is voluntary, not functioning properly in her case.
Thank you very much
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