Efficacy of tolterodine as a first‐line treatment for non‐neurogenic voiding dysfunction in children

Abstract

OBJECTIVE To assess the effect of antimuscarinic treatment with tolterodine combined with behavioural modification as a first‐line treatment, before invasive investigation, in children with non‐neurogenic voiding dysfunction but no obvious anatomical or neurogenic cause. PATIENTS AND METHODS The study comprised 44 children presenting with voiding dysfunction (30 girls and 14 boys, mean age 7 years, range 5–14); all had a noninvasive evaluation consisting of a history, urine analysis, renal and bladder ultrasonography and physical examination, with specific emphasis on the voiding pattern. Anticholinergic treatment with tolterodine (1 mg twice daily) was started in all patients; they were also informed about conservative management, including timed voiding, double voiding and relaxation of the pelvic floor during voiding. At the start and after 3 months, the dysfunctional voiding symptom score (DVSS) was completed twice by all patients. RESULTS For all patients the mean (sd) DVSS was 14.0 (2.67) and 6.68 (3.67) before and after treatment, respectively; the difference was statistically significant (P < 0.001). The mean scores for girls and boys, respectively, were 13.8 (2.79) and 14.5 (2.44) before and 6.43 (3.79) and 7.50 (3.34) after treatment. CONCLUSION Tolterodine combined with behavioural modification for dysfunctional voiding in children with no neurological or anatomical abnormality can be recommended as a first‐line treatment before invasive evaluation. Additionally, the DVSS appears to provide accurate and objective data for monitoring the effect of treatment in such children.

Prevalence of lower urinary tract symptoms in school-age children

“…Relevant epidemiological studies allow for the supposition that the prevalence of LUTD in children is variable, possibly affecting between 2% and 25% of the population [3][4][5][6][7][8][9][10][11][12]. Despite this disparity in the prevalence reported in studies, in which the informants are generally the parents, LUTD is common in the pediatric population and represents a challenge for specialized interdisciplinary teams.…”

Management of lower urinary tract dysfunction: A stepwise approach

“…Randomized controlled trials evaluating efficacy of anticholinergics as primary treatment in addition to BM have demonstrated improved subjective and objective outcomes [14,15]. Most subjects included in these studies had low post-void residuals, something that was found in less than 20% of our cohort.…”

Usefulness of a New Dysfunctional Voiding and Incontinence Scoring System in Predicting Treatment Effect in Children with Voiding Dysfunction

“…Lately, it has been reported that tolterodine tartrate which has a similar effect and less side effects than oxybutynin, should be used instead of this drug [14,20,22,[24][25][26] . In our study, tolerated side effects were seen in 10 patients, and the drug was found to be safe and effective.…”

“…Also, a recent concept is that the efficacy of treatment might be determined by clinical symptoms of patients. The touchstone of this idea is based on the first study performed by Farhat et al [12] about dysfunctional voiding symptom score and other subsequent studies [13,14] . Recently, another new dysfunctional voiding and incontinence scoring system (DVAISS) with a different questionnaire and scoring system has been developed by Akbal et al [15] , but its efficacy is not supported by clinical studies in the literature.…”