Oxybutynin, Cognition, and Incontinence

Abstract

Urology| October 01 2005 Oxybutynin, Cognition, and Incontinence AAP Grand Rounds (2005) 14 (4): 44. https://doi.org/10.1542/gr.14-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Oxybutynin, Cognition, and Incontinence. AAP Grand Rounds October 2005; 14 (4): 44. https://doi.org/10.1542/gr.14-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cognition, oxybutynin, urinary incontinence Source: Sommer BR, O’Hara R, Akari N, et al. The effect of oxybutynin treatment on cognition in children with diurnal incontinence. J Urol. 2005;173:2125–2127. Overactive bladder (spastic bladder) is common in both pediatric and adult patients. Recent studies have documented the deleterious effect of anticholinergic medication on the cognitive abilities of elderly patients.1 The authors, from the Stanford University Departments of Psychiatry and Urology, studied the impact of the anticholinergic oxybutynin on cognitive function in children. Twenty-five patients ages 5 to 17 years with daytime incontinence were treated with 4 weeks of behavior modification (including timed voiding). The study design initially called for randomization at this point to behavior modification or behavior modification plus oxybutynin. Parental resistance prevented randomization. Ten of the patients continued on isolated behavioral therapy while oxybutynin was added to the treatment of 15 patients. The patients were assigned based on parental preference. The baseline pretreatment cognitive battery was designed to assess memory, speed of processing, and attention. Testing included Buschke-style word list, Digit Symbol test, and Digit Span. Baseline cognitive function was lower in patients subsequently treated with oxybutynin. After controlling for the baseline discrepancies, oxybutynin treatment had no significant effect on the cognitive parameters measured. The authors speculate that children may have a “more robust cognitive resilience than the elderly.” Dr. McMahon has disclosed no financial relationships relevant to this commentary. In recent years, the use of anticholinergic medication has diminished greatly in most pediatric urology practices. Overactive bladder treatment in pediatric patients should focus primarily on behavioral techniques.2 A thorough history, noting the frequency of voids, accidents, and stools, is the initial step. Timed voiding and assurance of soft daily bowel movements are the initial recommendations; at times, formal biofeedback is helpful. Often, the primary problem is the child’s inability to relax his pelvic floor muscles. Treatment with anticholinergics actually can exacerbate these patients’ difficulties by impeding bladder emptying. If an anticholinergic is utilized, then post-void residual urine volume should be monitored (with ultrasound). There has been a proliferation of medications approved for adult patients with overactive bladder. Many of these medications are being marketed based on purportedly lower adverse-effect profiles (less muscarinic 1 receptor activity and more muscarinic 3 receptor specificity mean fewer central nervous system [CNS] problems, etc.). This study suggests that these issues may be less important in a pediatric population. Unfortunately, the small sample size and nonrandomized nature of this study leave open the possibility that significant cognitive impairment still can occur. We have seen pediatric patients who complain of CNS adverse effects with anticholinergic medications. Certainly, many patients have difficulty with constipation (which magnifies the voiding issues), dry mouth, and heat intolerance. The study, for reasons described in the commentary above, does not reassure us that oxybutynin is appropriate or safe for children with overactive bladder. You do not currently have access to this content.