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 followup 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 H2O in the compliant group (p < 0.001) and from 49.7 to 46.4 cm H2O in the noncompliant group (p = 0.21). The mean detrusor compliance increased from 18.9 to 19.3 ml/ cm H2O in the compliant group (p = 0.63) and from 11.8 to 12.3 ml/cm H2O 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.