title: Double anticholinergic therapy for refractory neurogenic and nonneurogenic detrusor overactivity in children: Long-term results of a prospective open-label study.
abstract: BACKGROUND
  In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin).
  
  
  METHODS
  This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients.
  
  
  RESULTS
  In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH2O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%).
  
  
  CONCLUSIONS
  With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Geneviève
authors.initials: G
authors.lastname: Nadeau
authors.affiliation: Department of Urology, Hospital for Sick Children, Toronto, ON.
authors.forename: Annette
authors.initials: A
authors.lastname: Schröder
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Katherine
authors.initials: K
authors.lastname: Moore
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Lucie
authors.initials: L
authors.lastname: Genois
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Pascale
authors.initials: P
authors.lastname: Lamontagne
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Micheline
authors.initials: M
authors.lastname: Hamel
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Eve
authors.initials: E
authors.lastname: Pellerin
authors.affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Québec, QC;
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bolduc