title: Double anticholinergic therapy for refractory overactive bladder.
abstract: OBJECTIVE
  Using 2 anticholinergic medications simultaneously (10 to 30 mg oxybutynin, 4 mg tolterodine and/or 5 to 10 mg solifenacin) we optimized the medical therapy for children in whom single agent anticholinergic therapy failed. We evaluated efficacy, tolerability and safety.
  
  
  METHODS
  Children with refractory overactive bladder and incontinence were included in a prospective, open label protocol. Study inclusion criteria were persistent symptoms on medical and behavioral therapy, absence of correctable neurological anomalies, and partial clinical and urodynamic responses on an optimal dose of 1 well tolerated, long acting anticholinergic. Patients were followed prospectively every 3 months. The primary end point was efficacy for continence and the secondary end points were tolerability and safety.
  
  
  RESULTS
  We enrolled 14 girls and 19 boys in the study, and followed 19 patients with neurogenic bladder and 14 with overactive bladder a minimum of 3 months. Mean age at enrollment was 12 years and double medication was given for a mean of 16 months (range 3 to 42). Mean +/- SD urodynamic capacity improved from 192 +/- 92 to 380 +/- 144 ml, no deterioration in compliance was noted and maximal contraction pressure decreased from 77 +/- 27 to 18 +/- 15 cm H(2)O. Continence improved in all patients, of whom 17 were dry, and 14 and 2 were significantly and moderately improved, respectively. No, mild and moderate side effects were reported by 12, 16 and 5 patients, respectively. In 3 of the 17 patients who voided greater than 20% post-void residual urine developed. Blood tests and electrocardiogram remained normal.
  
  
  CONCLUSIONS
  In children with refractory overactive bladder double anticholinergic therapy is an efficient and serious alternative to surgery. Patients and families were satisfied with this nonoperative, innovative approach.
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Québec, Canada. sbolduc_2002@yahoo.ca
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bolduc
authors.forename: Katherine
authors.initials: K
authors.lastname: Moore
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lebel
authors.forename: Pascale
authors.initials: P
authors.lastname: Lamontagne
authors.forename: Micheline
authors.initials: M
authors.lastname: Hamel
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D002648:Child; D003408:Cresols / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010665:Phenylpropanolamine / Q000627:therapeutic use*; D011446:Prospective Studies; D000068737:Tolterodine Tartrate; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D001559:Benzhydryl Compounds; D003408:Cresols; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C005419:oxybutynin