Long-term efficacy of tolterodine and patient compliance in pediatric patients with neurogenic detrusor overactivity.

INTRODUCTION

We investigated the effects of standard oral anticholinergic treatment with tolterodine in children with neurogenic bladder over a 5-year follow-up period and focused on treatment satisfaction, patient compliance and urodynamic parameters.

MATERIAL AND METHODS

The follow-up consisted of regular visits and urodynamic evaluation at least once a year. The patients or their parents were interviewed to evaluate voiding behavior, as well as factors leading to lower patient compliance and deterioration in urodynamic parameters.

RESULTS

Of the 43 patients evaluated, 30 (70%) took their anticholinergic medication consistently and 13 (30%) sporadically. The mean bladder capacity was 354.7 ml in the first group but only 214.7 ml in the noncompliant group (p < 0.001). The mean maximal detrusor pressure decreased from 42.2 to 33.6 cm H(2)O in the compliant group (p < 0.001) and from 49.7 to 46.4 cm H(2)O in the noncompliant group (p = 0.21). The mean detrusor compliance increased from 18.9 to 19.3 ml/cm H(2)O in the compliant group (p = 0.63) and from 11.8 to 12.3 ml/cm H(2)O in the noncompliant group (p = 0.87). Side effects such as dry mouth (11/13) and dizziness (7/13) were common in the noncompliant group, whereas only 5/30 reported dry mouth in the compliant group.

CONCLUSIONS

These data demonstrate the efficacy and tolerability of tolterodine over a long follow-up period. The results are promising in view of the fact that the patients will probably require life-long medication. Nevertheless, anticholinergic side effects still cause some patients to refuse regular medication, which results in a poorer urodynamic outcome.