[Treatment of bladder instability (non-neurogenic hyperactive bladder) in children, with tolterodine]

Overactive bladder (OB) is one of the no-neurogenic voiding dysfunctions whose prevalence has been precisely defined among the general population but not so among the paediatric population. Its clinical manifestations are various, and its association with other pathologies like enuresis, vesico-ureteral reflux (VUR) and recurrent infections is particularly significant in children. OB is basically managed with anticholinergic drugs. The efficacy of oxybutynin chloride has been sufficiently proved; however its dosage and side effects, although scarce in children, usually cause treatment discontinuation.

Tolterodine has been successfully used as an alternative therapy of OB in adults, however its use has not been sufficiently evaluated in children. Our objective is to determine tolterodine's efficacy and tolerability in the paediatric population suffering from OB.

A retrospective study of 72 children who were diagnosed no-neurogenic OB and who received no previous treatment. A concomitant urological pathology diagnostic protocol was applied to all cases, as well as a urodynamic test (UDT) and a neurological examination. Post-treatment UDT was performed to one group of patients.

The mean age was 10.9 years and the children were assessed between 4 and 31 months after treatment initiation. Healing was proved through cistomanometry in 67% of the cases, there was improvement in 14% and 19% of the patients showed no changes in the UDT. Following the criteria of the International Children's Continence Society (ICCS) applied to those children with no post-treatment UDT, 51% were healed, 27% improved and 22% experienced no changes. None of the patients had to discontinue the treatment due to side effects.

Tolterodine's tolerability and efficacy are good within the paediatric population, which turns it into an alternative to the traditional anticholinergics for the treatment of OB.