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Surgery is often necessary after failure of conservative therapy for urinary incontinence. Guidelines recommend urodynamic studies before surgery. A distinction is made between non-invasive (uroflowmetry) and invasive methods (cystometry and pressure-flow study, if necessary as combined videourodynamics, as well as urethral pressure profile). All examinations serve to objectify and quantify the symptoms, to correctly assign symptoms to the pathophysiology and anatomy as well as to identify risk factors, which often have a significant influence on the success of surgical therapy. Given appropriate experience, complications and often significant sequelae of bladder dysfunction affecting the patient's quality of life and life expectancy can be recognized. Urodynamic studies are performed to help narrow down potential diagnoses, to develop therapeutic strategies, and to obtain prognostic parameters. The following article is intended to provide some support.

Background: The aim of this non-interventional study was to evaluate the efficacy and tolerability of propiverine ER under real life conditions., Patients and Methods: The treatment of 5,565 patients with urge urinary incontinence, urgency or mixed urinary incontinence was documented over a 12-week period. Incontinence episodes, voiding frequency and voided volume were recorded at 3 visits (admission, after 4 and 12 weeks). Additionally the tolerability was evaluated at visits 2 and 3., Results: The average incontinence episodes/24 h decreased during therapy from 4.23 to 2.89. The frequency of micturitions/24 h decreased by 5.50. The voided volume improved by 69 ml. Approximately 92 % of investigators and patients assessed the efficacy similarly with "very good" and "good". Dry mouth was the most frequent adverse drug reaction and decreased from 16.5 % after 4 weeks to 13.6 % after 12 weeks of treatment., Conclusion: The efficacy and tolerability of propiverine ER were confirmed under real life conditions.

Background: Our aim was to evaluate the efficacy and tolerability of propiverine hydrochloride (propiverine) in daily practice and to check the risk-benefit relation using previously collected data on 4,390 patients., Patients and Methods: A total of 2,932 patients with symptoms of overactive bladder were treated with propiverine over a period of 12 weeks using a multicentre post marketing surveillance. At three visits (inclusion, after 4 weeks, after 12 weeks), parameters from the micturition diary (incontinence episodes, frequency of micturition, micturition volume) were recorded., Results: The number of incontinence episodes during daytime decreased during therapy from 3.6+/-3.8 to 1.2+/-2.3. The number of episodes at night decreased from 1.5+/-2.1 to 0.4+/-0.8 (both P<0.001). The mean volume per micturition improved during therapy (from 142.7 ml to 213.3 ml; +49.5%; P<0.0001). Some 85% of the investigators judged the efficacy of propiverine to be good or very good, 2.1% as not sufficient. The most frequent adverse event was dry mouth (17.3% of the patients after 12 weeks) mostly with low severity. More than 70% of the patients reported good or very good tolerability. Only 0.6% of the patients reported insufficient tolerability.

Purpose: The efficacy of propiverine in elderly patients suffering from urge incontinence or urge-stress incontinence was intended to be investigated. Especially in elderly patients a cardiac influence of propiverine is possible due to its dual mode of action. That is why besides the efficacy especially the cardiac safety was intended to be investigated., Material and Methods: Ninety-eight patients (21 male, 77 female; 67.7 +/- 6.3 years of age) suffering from urgency, urge incontinence or mixed urge-stress incontinence were included in the double-blind, multicentre, placebo-controlled, randomized study. After a two-week placebo run-in period, the patients received propiverine (15 mg t. i. d.) or placebo (t. i. d.) for four weeks. Before (U 1, U 2) and during the treatment period (U 3, U 4), standard ECG's and 24 h long-term ECG's were recorded., Results: Propiverine caused a significant reduction in the micturition frequency (U 2 : 8.7 +/- 4.2, U 4 : 6.5 +/- 3.2 ml; p < 0.01) reflected in a significant increase in the average micturition volume (U 2 : 163.5 +/- 65.9, U 4 : 216.3 +/- 101.5 ml; p < 0.01) and a significant reduction in the episodes of incontinence (- 54 %; p < or = 0.05). These findings were confirmed by the overall assessment after four weeks in which approximately 90 % of patients under propiverine were either free from urge incontinence and urge symptoms or improved. The efficacy parameters demonstrated a better efficacy for urge incontinence than for mixed urge-stress incontinence. Resting and ambulatory electrocardiograms evidenced no significant changes. Neither QTc interval nor other cardiac parameters were relevantly altered. The frequency of cardiac events (Lown classes IV a/b) was fortuitous, revealing no difference between placebo and propiverine. The incidence of adverse events was very low (2 % dryness of the mouth under propiverine) and confirmed by the findings from the quality of life questionnaires., Conclusions: A favourable benefit-risk ratio in the treatment of elderly patients suffering from urgency, urge incontinence or combined urge-stress incontinence is therefore proven for propiverine. Cardiac arrhythmia were not induced.

Kasuistics of Zoo animals with dystocia (Anoa, Giraffe, Snow goat, Scimitar horned Antelope, Bactrian camel, Tiger, Diana monkey) treated with special pharmaceuticals (glukokortikoids, cienbuterol, denaverine, carbetocin) and distance injections by blow darts are introduced. These procedures are described as very effective and save methods of obstetrics especially in Zoo animals.

On the basis of clinical and urodynamic results the authors adopt a definite attitude to the treatment of the urgency syndrome in the woman with the anticholinergic drug propiverin hydrochloride (Mictonorm). The results show a satisfactory improvement in 42 of 68 women (= 62%), whereas 24 of 68 women (= 35%) reported a subjective improvement of the clinical symptoms. These results correspond with the data from literature. In 15 women with no satisfactory effect the beta 2-sympathicomimetic drug clenbuterol (Contraspasmin) was additionally applied. There was a satisfactory success under this medication in 11 of the 15 women (= 72%). The results are discussed with the references of the literature to the conservative therapy of the urgency syndrome.

First report about therapeutic experiences with Mictonorm (Propiverinhydrochlorid) in the field of urogynaecology. Mictonorm is a new preparation and acts as a parasympathicolytic (anticholinergic) agent and also as a direct musculotropic relaxans. In 25 patients suffering from urge- or combined urge-stress incontinence a significant increase in the capacity of the urinary bladder, a significant decrease of the intravesical pressure and a distinct reduction of the complaints has been registered. Mictonorm is recommended for the treatment of urge-incontinence and other diseases with urge-symptoms (urgency, pollacisuria, enuresis etc.) and also as a adjuvant in the treatment of acute or chronic cystitis.

In a study for the recognition of the urodynamics of the detrusor after administration of the anticholinergic drug Mictonorm 14 patients with obstinate urge symptoms were examined. According to an examination plan every woman underwent three cystometric examinations each which were performed by means of a special urodynamic measuring device. Apart from a distinct improvement of the subjective complaints with the help of significantly different cystometry parameters the change of the urodynamics of the detrusor after therapy may be made evident in the results.

10 children with an unstable bladder were treated with the new anticholinergic drug Mictonorm. With the exception of one boy, the bladder capacity and the volume of all the other children increased. Contractions with amplitudes of 1.5 or 3.0 kPa had been registered. The extent of the maximum amplitudes was reduced. Both the enuresis nocturna and the enuresis diurna were positively influenced, the former, however, more so.

In a study about drug-induced changes of the urodynamics of the female urethra by Mictonorm 14 women with urge-symptoms were investigated. According to a special examination plan the control of Mictonorm-effect was realized with the analysis of the parameters of the urethra pressure profile at rest and under stress conditions and of the vesico-urethral pressure transmission. The result shows that there were no significant changes of the urodynamics of the female urethra, therefore one can accept selective detrusor effects by oral application.

The motor urge incontinence is characterized through a hyperactivity of the detrusor muscle. Whereas in the secundar form of motor urge incontinence the evoked moment must be abolished in the primar form no method of choice exist. Many different drugs are used in the pharmacological therapy. Biofeedback will be more important in the future. The sensor urge incontinence is caused through urethral relaxation. For the objective assessment must be taken out intraurethral pressure measurements. In this measurements it gives some problems due to the influence of physiological functions.

In fourteen patients with a pronounced Parkinson syndrome of cerebral atherosclerotic or dostencephalitic genesis, good to very good success can be achieved with an average dosage of 3--4 tablets, three times a day (=45--60 mg) of the test substance, which is a bencilic acid ester preparation. The tremor, hypokinesis, and the psychic syndrome were particularly favourably affected. This success was also achieved in clinical pictures which had already lasted more than ten years.

The new anticholinergic agent Propiverinhydrochlorid (Mictonorm) is used in the treatment of the Enuresis nocturna et diurna combined with urgency, frequency and small amounts of voided urine. The urodynamic investigation shows an unstable bladder. No urinary tract obstruction or neurogenic injuries are detected at the 26 normal-developed children of 5-11 years of age. Mictonorm was given for 3 months, in a dosage of 0,4 mg/kg bw/d. The bladder capacity, the volume at the desire to void and the compliance of the detrusor significantly increased and the frequency decreased. Application of placebo shows no variation of these parameters. No side-effects were to be distinguish. The wetting improved significantly in 16 of the 26 children but dryness seldom was reached. Therefore the dose was doubled in 19 children at the fourth month, and a second equal group of 26 children primary was treated with 0,7-0,8 mg/kg bw/d. With good compatibility especially the higher dose given from the beginning improved the enuresis better. All children showed a more distinct influence to the enuresis diurna than to the nocturna. The prescription of the anticholinergic neurotrope and myotrope drug is interpreted as a part of the management of the wetting child and its environment.

In the context of treating hyperactivity of the detrusor the newly developed preparation Propiverin (Mictonorm) is presented. It is postganglionic and anticholinergic and mainly acts peripherally and selectively on the bladder. At the same time a musculotropic relaxing effect with a specific affinity to the unstriated musculature of the bladder can be demonstrated in experiments on animals. In our urodynamic investigations the application of the medicament resulted in an increase in bladder capacity, a reduction of urge symptoms, a decrease in bladder tension and a depression of the uroflow. These results justify the clinical use of Propiverin after appropriate urodynamic diagnostic checks.