Posterior Urethral Valves Medication

Updated: Apr 02, 2020
  • Author: Martin David Bomalaski, MD, FAAP; Chief Editor: Marc Cendron, MD  more...
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Medication

Medication Summary

Posterior urethral valves (PUVs) initially represent a surgical condition. However, long-term treatment often comprises a combination of medical and surgical treatment, primarily directed at the bladder. The primary medications involved in bladder management are anticholinergic medications used to improve bladder compliance. Other medications that may be needed include prophylactic antibiotics and medications used in the management of renal insufficiency.

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Anticholinergic agents

Class Summary

These agents are used to improve bladder capacity and compliance in the patient with elevated detrusor pressures, which may cause hydronephrosis, UTI, or incontinence. Early use of anticholinergic therapy has been associated with improved bladder function in infants with high voiding pressures and low storage volumes. [24]

Oxybutynin chloride (Ditropan)

Inexpensive and effective, oxybutynin chloride long has been the first-line anticholinergic. By inhibiting muscarinic action of acetylcholine on smooth muscle, exerts antispasmodic effect on bladder muscle. Its nonselective anticholinergic action increases adverse effects; however, it may produce fewer adverse effects if dosing is gradually increased over >2 wk. Available in both 5-mg tab and 5-mg/5-mL elixir. A long-acting 10-mg tab with once-a-day dosing was recently introduced but is expensive and has been approved only for adults.

Hyoscyamine sulfate (Levbid, Levsin)

Works by inhibiting postganglionic cholinergic receptors on smooth muscle cells. Rapidly absorbed and distributed throughout body, including across blood-brain barrier. Half-life is 3.5 h; excreted unchanged in urine.

Available in PO, IV, and SL forms; tab generally used for treatment of PUV. Time-release formulation available. Elixir and drops available.

Tolterodine (Detrol)

A new antimuscarinic drug with more selective receptor profile targeted for detrusor smooth muscle. Used extensively in adults but not approved by FDA for children. In adults, demonstrated equal in efficacy to oxybutynin chloride with significantly fewer adverse effects. Available in 1- and 2-mg tab.

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Antibiotics

Class Summary

Patients with history of recurrent UTI may benefit from antibiotic prophylaxis, especially in the presence of vesicoureteral reflux. The ideal antibiotic for urinary prophylaxis is safe, effective, inexpensive, and has no adverse effects. Although no antimicrobial is ideal, some are preferred in children. Prophylactic dosage is usually one quarter of the therapeutic dose administered once per day. Too high a dose increases adverse effects (eg, GI upset) and may alter fecal flora. More appropriate antibiotics in children include trimethoprim (TMP), sulfamethoxazole (SMZ), nitrofurantoin, and amoxicillin. In addition, antibiotic therapy may lead to bacterial resistance, which may reduce options in the treatment of infection.

Trimethoprim and sulfamethoxazole (Bactrim, Septra, Cotrim)

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. TMP alone or in combination with SMZ is the most commonly used antibiotic for both treatment and prophylaxis of UTI. Inexpensive and has minimal adverse effects on bowel and vaginal flora because excreted and concentrated in urine. Pediatric susp (40 mg TMP and 200 mg SMZ per 5 mL) available.

Nitrofurantoin (Furadantin, Macrodantin, Macrobid)

Synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. Bacteriostatic at low concentrations (5-10 mcg/mL) and bactericidal at higher concentrations.

Another common prophylactic antimicrobial agent, which is also excreted in urine, allowing urinary levels to be high while having few effects on fecal flora. Inexpensive and comes in both liquid and tab preparations. Rarely, associated with peripheral neuropathy and pulmonary hypersensitivity. SR formulation available; liquid susp (25 mg/5 mL) also available.

Amoxicillin (Trimox, Amoxil)

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Used as prophylaxis in certain PO, GI, or genitourinary procedures.

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