UroToday - In a recent journal article, Dr. Pramod Reddy et al. evaluated the long-term (12 months and over) efficacy and safety of tolterodine in children with neurogenic detrusor overactivity. All the patients successfully completed 1 of 3 12-week, open-label studies and had stable neurologic disease and urodynamic evidence of neurogenic detrusor overactivity requiring intermittent catheterization. Drug formulation and dosing were based on age (4 months-4 years = tolterodine oral solution 0.2-2 mg twice daily; 5-10 years = tolterodine oral solution 0.5-4 mg twice daily; 11-16 years = tolterodine extended-release capsules 2, 4, or 6 mg once daily). Daily doses were individualized for each subject. Efficacy was evaluated urodynamically and using parent-completed 3-day bladder diaries.

Overall, 30 patients were enrolled, and the group found that functional bladder capacity increased by month 12 in the younger age groups but not in the oldest subjects. Volume to first detrusor contraction >10 cm H2O pressure and detrusor leak point pressure did not change in any age group. The number of incontinence episodes per 24 hrs decreased in all subjects, as did the number of catheterizations per 24 hrs. Mean volume per catheterization increased in all subjects. Seven treatment-related adverse events were reported.

The group concluded that both tolterodine formulations were effective and well tolerated in children with neurogenic detrusor overactivity. If we are dealing with children with not just neurogenic detrusor overactivity, but also a neuropathic bladder with detrusor overactivity and incontinence, maximizing medical management is of the utmost importance. We need to maximize the medical therapy in an effort to avoid any type of invasive intervention. If catheterization is part of the regimen, one should also consider overnight catheter drainage to keep bladder pressures low for a period of time where catheterization is not being implemented (i.e. during sleep).

Reddy PP, Borgstein NG, Nijman RJ, Ellsworth PI
J Pediatr Urol. 2008 Dec;4(6):428-33
UroToday Medical Editor Pasquale Casale, MD

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