Response to anticholinergic therapy and its predictors in pediatric overactive bladder

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.