Should we switch over to tolterodine in every child with non-neurogenic daytime urinary incontinence in whom oxybutynin failed?
OBJECTIVE
To assess the clinical efficacy of tolterodine prescribed to children with non-neurogenic daytime urinary incontinence secondary to overactive bladder who had previously failed to improve with oral oxybutynin treatment and its relation to the side-effect profile and compliance status.


METHODS
We evaluated 92 children presenting with daytime wetting, with or without nocturnal enuresis, who were receiving oral oxybutynin treatment. Children with chronic urinary tract infections, a neurologic lesion, an anatomic abnormality of lower urinary tract, voiding abnormality, and less than 1 year of oxybutynin treatment were excluded. Of the remaining 41 children (mean age 7.2 years, range 5 to 14 years), 30 agreed to switch to tolterodine and 11 continued receiving oxybutynin. Anticholinergic side effects, compliance, and clinical efficacy were assessed in the follow-up.


RESULTS
Of the 30 patients who switched to tolterodine, a complete response was in 18 patients (60%), partial improvement in 11 (37%), and no improvement in 1 (3%) after a mean of 14.4 months (range 12 to 16 months) of oxybutynin treatment. The anticholinergic side-effect score was 7.2, 9.3, and 11, respectively, for those with a complete response, partial improvement, and no improvement in the compliant group. The noncompliant group had the greatest side-effect score (16.9). The fairly compliant group had a side-effect score of 12.3. After a mean of 7.1 months (range 6 to 9 months) of tolterodine use, a complete response was reported in 24 patients and partial improvement in 5 (17%). In 1 patient, treatment failed completely. However, his side-effect score decreased from 11 to 2. All tolterodine users were compliant with treatment.


CONCLUSIONS
The results of this study in children with non-neurogenic daytime urinary incontinence have shown that tolterodine may increase the efficacy of pharmacotherapy, particularly in patients noncompliant to oxybutynin. Additional investigation of the anticholinergic side-effect scores and compliance tables is required to improve the clinical results of pharmacotherapy in incontinence due to overactive bladder in children.
Yucel
Selcuk
S
Section of Pediatric Urology, Akdeniz University School of Medicine, Antalya, Turkey. syucel@akdeniz.edu.tr
Akkaya
Erdem
E
Guntekin
Erol
E
Kukul
Erdal
E
Danisman
Ahmet
A
Akman
Sema
S
Baykara
Mehmet
M
D000293:Adolescent; D001521:Behavior Therapy; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003408:Cresols / Q000627:therapeutic use*; D004341:Drug Evaluation; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use; D010349:Patient Compliance; D010665:Phenylpropanolamine / Q000627:therapeutic use*; D000068737:Tolterodine Tartrate; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000628:therapy
D001559:Benzhydryl Compounds; D018680:Cholinergic Antagonists; D003408:Cresols; D008333:Mandelic Acids; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C005419:oxybutynin