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Response to anticholinergic therapy and its predictors in pediatric overactive bladder
1Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Pediatric Urology, Istanbul, Turkey. ademcanbaz@gmail.com.
Insights
Anticholinergic medications are effective for treating pediatric overactive bladder (OAB), with similar outcomes but varying side effects. Tolterodine showed better results than oxybutynin, while increased daily voids indicated a poorer response.
Area of Science:
- Pediatric Urology
- Pharmacology
- Clinical Medicine
Background:
- Pediatric overactive bladder (OAB) treatment primarily involves standard urotherapy and anticholinergic agents.
- Previous findings indicate oxybutynin may cause more adverse effects than tolterodine or propiverine, despite comparable treatment efficacy.
- New insights reveal tolterodine's potential to enhance complete response rates and the impact of daily voiding frequency on treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy of anticholinergic medications in treating pediatric overactive bladder (OAB).
- To identify clinical factors influencing treatment success in children with OAB.
- To compare the effectiveness and side effect profiles of different anticholinergic agents.
Main Methods:
- Retrospective analysis of demographic and clinical data from 164 children diagnosed with OAB.
- Assessment of treatment response to urotherapy and three anticholinergic agents: oxybutynin, propiverine, and tolterodine.
- Categorization of treatment response into complete, partial, or non-response, alongside analysis of side effects and clinical factors.
Main Results:
- Urotherapy alone was effective in 20.1% of cases; the remaining patients required anticholinergic treatment.
- Overall success rate for anticholinergic treatment was 95.4% (125/131), with 85.5% achieving complete response.
- Propiverine and tolterodine exhibited fewer side effects than oxybutynin (p=0.027). Higher daily void frequency correlated with increased odds of partial/no response (OR: 1.15, p=0.039).
- Tolterodine use was associated with decreased odds of partial/no response (OR: 0.15, p=0.023).
Conclusions:
- Anticholinergic agents demonstrate comparable efficacy in managing pediatric OAB.
- Oxybutynin is associated with a higher incidence of side effects compared to propiverine and tolterodine.
- Tolterodine may improve the likelihood of a complete response, whereas increased daily void frequency is linked to a greater chance of incomplete response.
Purpose:
The treatment of overactive bladder (OAB), which is commonly seen in children, is primarily based on standard urotherapy and anticholinergics. This study aimed to evaluate the efficacy of anticholinergics in OAB and clinical factors affecting treatment outcomes.
Methods:
The data of children with OAB included demographic and clinical data, Dysfunctional Voiding Symptom Score, and voiding diaries. Three anticholinergic agents-oxybutynin, propiverine, and tolterodine-were assessed. The treatment response was categorized as complete, partial, or non-response.
Results:
Of 164 patients, 20.1% responded to urotherapy, while the remaining (mean age 7.7 ± 3.3 years; 54.2% male) required anticholinergic treatment. The first-line anticholinergic was oxybutynin in 86 (65.6%) patients, propiverine in 30 (22.9%), and tolterodine in 15 (11.5%). Treatment outcomes were similar (p = 0.35), but propiverine and tolterodine had fewer side effects than oxybutynin (p = 0.027). The overall success rate was 95.4% (n = 125), with 85.5% (n = 112) achieving complete and 9.9% (n = 13) partial responses. Higher daily voids were correlated with raised odds of a partial/no response to initial anticholinergic (OR: 1.15, 95% CI: 1.01-1.32, p = 0.039). Tolterodine correlated with decreased odds of partial/no response (OR: 0.15, 95% CI: 0.03-0.77, p = 0.023).
Conclusion:
Anticholinergics show similar efficacy in treating OAB, though oxybutynin is associated with more side effects. Tolterodine reduced the odds of non-complete response, while a higher daily voids increased it.
Trial Registration:
NCT07046156, date of registration: 30/06.2025 retrospectively registered.
What Is Known:
• Treatment of overactive bladder in children mainly relies on standard urotherapy and anticholinergic agents.
What Is New:
• Oxybutynin caused more adverse effects than tolterodine or propiverine despite similar treatment outcomes. • Tolterodine increased the likelihood of complete response, while a higher number of daily voids reduced it.
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