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Use of tolterodine in children with dysfunctional voiding: an initial report
M Munding1, H Wessells, B Thornberry
1Section of Urology, The University of Arizona College of Medicine, Tucson, Arizona, USA.
Insights
Tolterodine effectively reduced wetting episodes in children with dysfunctional voiding, showing promise for pediatric incontinence treatment. Further trials are needed to confirm safety and efficacy in this population.
Area of Science:
- Pediatric Urology
- Pharmacology
- Clinical Trials
Background:
- Tolterodine is approved for adult overactive bladder and incontinence.
- It exhibits a favorable side effect profile compared to oxybutynin.
- Dysfunctional voiding is a common cause of urinary incontinence in children.
Purpose of the Study:
- To evaluate the safety and efficacy of tolterodine in pediatric patients diagnosed with dysfunctional voiding.
- To assess treatment outcomes using standardized definitions for incontinence episodes.
Main Methods:
- Retrospective review of 30 pediatric patients treated with adult doses of tolterodine.
- Patients received behavioral modifications alongside tolterodine treatment.
- Outcomes were classified as cured, improved, or failed based on reduction in wetting episodes.
Main Results:
- The study included children aged 4-17 years, treated for an average of 5.2 months.
- Tolterodine demonstrated a cure rate of 33% and improvement in 40% of cases.
- A low incidence of side effects (13.3%) was observed, with only one discontinuation due to diarrhea.
Conclusions:
- Tolterodine, administered at adult doses without titration, appears safe and effective for reducing wetting episodes in children with dysfunctional voiding.
- Further controlled clinical trials are recommended to comprehensively assess the efficacy and safety of tolterodine in pediatric populations.
Purpose:
Tolterodine was recently approved for the treatment of incontinence and overactive bladder in adults, and has fewer side effects than oxybutynin. We evaluated the safety and efficacy of tolterodine in children with dysfunctional voiding.
Materials And Methods:
We retrospectively reviewed our experience with 30 pediatric patients treated with tolterodine for a primary diagnosis of dysfunctional voiding. Patients were treated with adult doses of tolterodine and behavioral modifications. Standard definitions determined by the International Children's Continence Society were adapted to designate final treatment outcomes on medication as cured-greater than 90% reduction in wetting episodes, improved-greater than 50% reduction or failed-less than 50% reduction.
Results:
The children were 4 to 17 years old (mean age 8.7) and were treated with tolterodine for an average of 5.2 months. The final dose was 1 mg. twice daily in 1, 2 mg. twice daily in 27 and 4 mg. twice daily in 2 patients. Wetting episodes were cured in 10 (33%), improved in 12 (40%), and failed to show improvement in 8 (27%) cases. Four patients (13.3%) reported side effects and only 1 discontinued the medication due to diarrhea. There were no reports of hyperpyrexia, flushing or intolerance to sunshine and outdoor temperature.
Conclusions:
Our results demonstrate that tolterodine at adult doses without titration can be used safely to decrease wetting episodes in children with dysfunctional voiding. Controlled clinical trials should be completed to evaluate further efficacy and safety in children.