title: Comparison of the Effects by Obybutynin and Tolterodine on Spina Bifida Patients: A Pilot Crossover Study.
abstract: OBJECTIVE
  To compare the effects of obybutynin and tolterodine in neurogenic bladder patients with spina bifida in a crossover study.
  
  
  METHODS
  Seven myelomeningocele and one spinal lipoma cases, maintained with obybutynin and clean intermittent catheterization for more than 60 months, were enrolled. Age ranged from 8 to 23 years (mean 12.0, male/ female = 2/6). After 2 weeks of washout period, obybutynin (0.3 mg/kg, maximum 12 mg) or tolterodine (0.12 mg/kg, maximum 4 mg) was administered for 4 weeks, and then switched to the other drug for 4 weeks. At the end of the three periods, the patients and/or parents documented urinary storage status and adverse effects, and urodynamic study was performed.
  
  
  RESULTS
  In seven cases undergoing sequential urodynamic study, the baseline compliance of the patients (6.81 ± 1.83) increased to 9.98 ± 4.97 by obybutynin and 10.16 ± 2.53 by tolterodine (P < 0.05 for each). Better compliance was noted in two cases with tolterodine and in two cases with obybutynin. Stronger adverse effects were reported in three out of eight patients (37.5%) by obybutynin and three out of eight patients (37.5%) by tolterodine. Although storage effect and side effects were equivalent for total patients, markedly diverse response was noted for each patient, with five choosing tolterodine and three choosing obybutynin.
  
  
  CONCLUSIONS
  Individualized evaluation is required for optimal choice of anticholinergics.
authors.affiliation: Department of Urology, Kyoto University, Kyoto, JapanUrology Clinic, Shiga Medical Center for Children, Moriyama, JapanDepartment of Urology, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kanematsu
authors.affiliation: Department of Urology, Kyoto University, Kyoto, JapanUrology Clinic, Shiga Medical Center for Children, Moriyama, JapanDepartment of Urology, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Johnin
authors.affiliation: Department of Urology, Kyoto University, Kyoto, JapanUrology Clinic, Shiga Medical Center for Children, Moriyama, JapanDepartment of Urology, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: Department of Urology, Kyoto University, Kyoto, JapanUrology Clinic, Shiga Medical Center for Children, Moriyama, JapanDepartment of Urology, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Imamura
authors.affiliation: Department of Urology, Kyoto University, Kyoto, JapanUrology Clinic, Shiga Medical Center for Children, Moriyama, JapanDepartment of Urology, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
keywords: neurogenic bladder; obybutynin; spina bifida; tolterodine