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Efficacy and tolerability of tolterodine in children with detrusor hyperreflexia
C Goessl1, T Sauter, T Michael
1Department of Urology, Benjamin Franklin Medical School, Free University of Berlin, Berlin, Germany.
Insights
Tolterodine shows promise for treating pediatric detrusor hyperreflexia, offering improved bladder capacity and reduced pressure with good tolerability. It appears as effective as oxybutynin chloride in children.
Area of Science:
- Pediatric Urology
- Pharmacology
- Urodynamics
Background:
- Detrusor hyperreflexia in children can lead to significant bladder dysfunction.
- Current treatments like oxybutynin chloride have limitations in efficacy and tolerability.
- Novel antimuscarinic agents are needed to improve management of pediatric overactive bladders.
Purpose of the Study:
- To evaluate the urodynamic effects of tolterodine in children with detrusor hyperreflexia.
- To assess the tolerability of tolterodine in this pediatric population.
- To compare tolterodine's efficacy and safety with oxybutynin chloride.
Main Methods:
- A study involving 22 children (3 months to 15 years) diagnosed with detrusor hyperreflexia.
- Children received tolterodine (0.1 mg/kg/day) as either initial therapy or a switch from oxybutynin.
- Urodynamic re-evaluation was performed within 3 months of commencing tolterodine treatment.
Main Results:
- Tolterodine significantly increased maximum bladder capacity (+44%) and detrusor compliance (+55%).
- Mean maximum detrusor pressures decreased significantly by 46% with tolterodine use.
- Tolterodine demonstrated comparable urodynamic effects to oxybutynin and was well-tolerated, with only one mild adverse event.
Conclusions:
- Tolterodine is an effective treatment for pediatric detrusor hyperreflexia, improving key urodynamic parameters.
- The drug appears to be better tolerated than oxybutynin chloride in pediatric patients.
- Further research with larger cohorts is warranted to confirm these findings.
Objectives:
To investigate the urodynamic effects and tolerability of the new antimuscarinic drug tolterodine in children with detrusor hyperreflexia.
Methods:
Twenty-two children (12 boys and 10 girls; age range 3 months to 15 years, mean age 5.7 years) with detrusor hyperreflexia resulting in maximum detrusor pressures exceeding 40 cm H(2)O during filling cystotonometry were enrolled to receive tolterodine tartrate (a total of 0.1 mg/kg orally daily, divided into two doses) either as a first-line therapy (n = 12, group 1) or replacing oxybutynin chloride therapy (n = 10, group 2). Within 3 months, all patients underwent urodynamic re-evaluation during ongoing tolterodine treatment.
Results:
In group 1, the mean maximum bladder capacity increased from 120.2 to 173.0 mL (+44%), the mean detrusor compliance increased from 8.7 to 13.5 mL/cm H(2)O (+55%), and the mean maximum detrusor pressures decreased from 70.1 to 37.9 cm H(2)O (-46%); the differences were significant (P < 0.001). In group 2, no differences in the urodynamic effects of oxybutynin versus tolterodine were noted. Only 1 patient experienced a transient and moderately adverse effect with tolterodine.
Conclusions:
Although based on a limited number of subjects, these data indicate that in pediatric patients with detrusor hyperreflexia, tolterodine may be better tolerated than and equally effective as the standard drug oxybutynin chloride.