Research article summary (published 18 Aug 2009):

Double anticholinergic therapy for refractory overactive bladder.

Full Abstract

PURPOSE: Using 2 anticholinergic medications simultaneously (10 to 30 mg oxybutynin, 4 mg tolterodine and/or 5 to 10 mg solifenacin) we optimized the medical therapy for children in whom single agent anticholinergic therapy failed. We evaluated efficacy, tolerability and safety. MATERIALS AND METHODS: Children with refractory overactive bladder and incontinence were included in a prospective, open label protocol. Study inclusion criteria were persistent symptoms on medical and behavioral therapy, absence of correctable neurological anomalies, and partial clinical and urodynamic responses on an optimal dose of 1 well tolerated, long acting anticholinergic. Patients were followed prospectively every 3 months. The primary end point was efficacy for continence and the secondary end points were tolerability and safety. RESULTS: We enrolled 14 girls and 19 boys in the study, and followed 19 patients with neurogenic bladder and 14 with overactive bladder a minimum of 3 months. Mean age at enrollment was 12 years and double medication was given for a mean of 16 months (range 3 to 42). Mean +/- SD urodynamic capacity improved from 192 +/- 92 to 380 +/- 144 ml, no deterioration in compliance was noted and maximal contraction pressure decreased from 77 +/- 27 to 18 +/- 15 cm H(2)O. Continence improved in all patients, of whom 17 were dry, and 14 and 2 were significantly and moderately improved, respectively. No, mild and moderate side effects were reported by 12, 16 and 5 patients, respectively. In 3 of the 17 patients who voided greater than 20% post-void residual urine developed. Blood tests and electrocardiogram remained normal. CONCLUSIONS: In children with refractory overactive bladder double anticholinergic therapy is an efficient and serious alternative to surgery. Patients and families were satisfied with this nonoperative, innovative approach.

Author information

Author/s: Bolduc, Stéphane (S); Moore, Katherine (K); Lebel, Sylvie (S); Lamontagne, Pascale (P); Hamel, Micheline (M);

Affiliation: Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Québec, Canada. sbolduc_2002(-atsign-)yahoo.ca

Journal and publication information

Publication Type: Clinical Trial; Journal Article

Journal: The Journal of urology (J Urol), published in United States. (Language: eng)

Reference: 2009-Oct; vol 182 (issue 4 Suppl) : pp 2033-8

Dates: Created 2009/09/14; Completed 2009/10/29;

PMID: 19695628, status: MEDLINE (last retrieval date: 10/29/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Urol. 2009 Oct;182(4 Suppl):2038-9; discussion 2039. (PMID: 19695625)

CommentIn: J Urol. 2009 Oct;182(4 Suppl):2038; discussion 2039. (PMID: 19695627)

CommentIn: J Urol. 2009 Oct;182(4 Suppl):2038; discussion 2039. (PMID: 19695626)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Algorithms Benzhydryl Compounds - therapeutic use Child Cresols - therapeutic use Drug Therapy, Combination Female

Humans Male Mandelic Acids - therapeutic use Muscarinic Antagonists - therapeutic use Phenylpropanolamine - therapeutic use Prospective Studies Urinary Bladder, Overactive - drug therapy

Associated Chemicals: Benzhydryl Compounds (0) ; Cresols (0) ; Mandelic Acids (0) ; Muscarinic Antagonists (0) ; tolterodine (124937-51-5) ; Phenylpropanolamine (14838-15-4) ; oxybutynin (5633-20-5)

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