title: Efficacy of tolterodine as a first-line treatment for non-neurogenic voiding dysfunction in children.
abstract: OBJECTIVE
  To assess the effect of antimuscarinic treatment with tolterodine combined with behavioural modification as a first-line treatment, before invasive investigation, in children with non-neurogenic voiding dysfunction but no obvious anatomical or neurogenic cause.
  
  
  METHODS
  The study comprised 44 children presenting with voiding dysfunction (30 girls and 14 boys, mean age 7 years, range 5-14); all had a noninvasive evaluation consisting of a history, urine analysis, renal and bladder ultrasonography and physical examination, with specific emphasis on the voiding pattern. Anticholinergic treatment with tolterodine (1 mg twice daily) was started in all patients; they were also informed about conservative management, including timed voiding, double voiding and relaxation of the pelvic floor during voiding. At the start and after 3 months, the dysfunctional voiding symptom score (DVSS) was completed twice by all patients.
  
  
  RESULTS
  For all patients the mean (sd) DVSS was 14.0 (2.67) and 6.68 (3.67) before and after treatment, respectively; the difference was statistically significant (P < 0.001). The mean scores for girls and boys, respectively, were 13.8 (2.79) and 14.5 (2.44) before and 6.43 (3.79) and 7.50 (3.34) after treatment.
  
  
  CONCLUSIONS
  Tolterodine combined with behavioural modification for dysfunctional voiding in children with no neurological or anatomical abnormality can be recommended as a first-line treatment before invasive evaluation. Additionally, the DVSS appears to provide accurate and objective data for monitoring the effect of treatment in such children.
authors.affiliation: Department of Urology, Medical Faculty, Cumhuriyet University, Sivas, Turkey. sayan@cumhuriyet.edu.tr
authors.forename: Semih
authors.initials: S
authors.lastname: Ayan
authors.forename: Kemal
authors.initials: K
authors.lastname: Kaya
authors.forename: Kahraman
authors.initials: K
authors.lastname: Topsakal
authors.forename: Hakan
authors.initials: H
authors.lastname: Kilicarslan
authors.forename: Gokhan
authors.initials: G
authors.lastname: Gokce
authors.forename: Yener
authors.initials: Y
authors.lastname: Gultekin
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003408:Cresols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010665:Phenylpropanolamine / Q000627:therapeutic use*; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D014555:Urination Disorders / Q000628:therapy*
chemical_list: D001559:Benzhydryl Compounds; D003408:Cresols; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate