A Clinical and Urodynamic Study on the Effects of Oral Tolterodine on Serial Alterations in Neurogenic Detrusor Overactivity vis-à-vis Oral Oxybutynin in Children (Existing Oxybutynin Users)

Objective: Tolterodine has proved effective for treating non-neurogenic overactive bladder in Paediatric patients but has been less well studied in children with neurogenic detrusor overactivity. The objective of the current study was to look for incremental benefits of tolterodine (if any) in patients who are already being treated with oxybutynin. Methods: Patients with neurogenic bladder who were on oxybutynin at least for a period of 6 months were retrospectively analysed. Oxybutynin was switched over to tolterodine and prospectively analysed. The clinical and the urodynamic parameters were compared after completion of 6 months of tolterodine therapy. Results: Thirty patients with neurogenic bladder were included in the study. There were significant improvement in MCC (Median = 199.5 ml), LPP (Median = 52.5 cm H2O), volume at detrusor pressure 40 cm H2O (157 ml) after oxybutynin and MCC (226.5 ml), LPP (46 cm H2O), volume at detrusor pressure 40 cm H2O (158 ml) after tolterodine against the basal value of 134 ml, 56 cm H2O, 93 ml respectively. There were incremental benefits of tolterodine over oxybutynin in all the symptoms and urodynamic parameters but the benefits were not statistically significant. The number of adverse events of oxybutynin was 9 whereas with tolterodine it was 4 which are statistically significant. Conclusion: There is significant improvement in all the urodynamic parameters and symptoms after the treatment with oxybutynin as well as tolterodine. There are incremental benefits of tolterodine over oxybutynin but the gain is not statistically significant.