Oxybutynin In Children Research Articles

Editorial comment

This retrospective study investigates variables that relate to a response to oxybutynin in children with voiding problems. Although 541 patients were seen during the period of review, only 81 patients were included. I deduce that 460 or 85% of the total dysfunctional voiders were managed without medication—perhaps this is a number worth remembering, as it differs from my own experience. Although many tools were used to evaluate this group, the only significant variable predicting success with oxybutynin was the frequency of wetting before treatment. The study finds that children who wet less often achieved dryness at a significantly greater rate using sustained release oxybutynin than those children who wet more often at presentation. This is a bit disappointing. A child was more likely to be dry on medication if they did not wet to begin with. Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladderUrologyVol. 67Issue 5PreviewTo examine the variables relative to the response of oxybutynin treatment in children with daytime urinary incontinence. Full-Text PDF

Comparison of the effectiveness and side‐effects of tolterodine and oxybutynin in children with detrusor instability

Treatment with anticholinergic agents is the mainstay of therapy for detrusor instability (DI), a chronic and morbid condition characterized by urge urinary incontinence. The aim of this study is to assess the effectiveness and tolerability of tolterodine and oxybutynin in children with DI. A total of 60 children with DI were enrolled, 30 (14 male, 16 female, mean age 7.97+/-2.71 years) in the tolterodine group and 30 (12 male, 18 female, mean age 7.33+/-2.23 years) in the oxybutynin group. In this prospective study we reviewed data from 60 children followed for at least 6 months. All of the patients in the study population had a history of dysfunctional voiding. Urodynamic investigations were conducted in all of the patients before and after anticholinergic treatment. Episodes of urge urinary incontinence and adverse events were also evaluated. Improvements in urge incontinence episodes were similar for the children who received tolterodine or oxybutynin. Improvements in the urodynamic parameters were also the same in the two groups. Adverse events were significantly lower in the tolterodine group (13 events in 13 patients) compared to the oxybutynin group (27 events in 20 patients; P=0.027). Reductions in urge urinary incontinence episodes were similar with tolterodine and oxybutynin in children with DI. Side-effects were more common with oxybutynin. Treatment of children with DI with tolterodine shows significantly better tolerability and this may enhance children's compliance during long-term treatment.

Efficacy and safety of propiverine in cpomparison to oxybutynin in children with neurogenic detrusor overactivity: an observational study

ss Open Acce Oral presentation Efficacy and safety of propiverine in cpomparison to oxybutynin in children with neurogenic detrusor overactivity: an observational study J Nounla*1, U Rolle1, H Madersbacher2, G Murtz3, S Alloussi4, M Beuke5, M Burst6, B Domurath7, T Henne8, I Korner8, A Niedeggen1, J Pannek1, M Schuldt1, H Schulte-Baukloh1, D Schultz-Lampel1, S Siemer1, T Stuckert1, B Willer1, P Bock1 and J Hanisch1

TOLTERODINE TREATMENT FOR CHILDREN WITH SYMPTOMS OF URINARY URGE INCONTINENCE SUGGESTIVE OF DETRUSOR OVERACTIVITY: RESULTS FROM 2 RANDOMIZED, PLACEBO CONTROLLED TRIALS

We report the results of the first 2 large randomized controlled trials designed to evaluate the efficacy and safety of tolterodine extended release in children 5 to 10 years old with symptoms of urinary urge incontinence suggestive of detrusor overactivity. Two double-blind, placebo controlled trials were conducted sequentially. Children 5 to 10 years old with incontinence suggestive of detrusor overactivity (1 or more diurnal incontinence episodes per 24 hours) were randomized to tolterodine (2 mg daily) or placebo for 12 weeks. The primary end point was the change from baseline to week 12 in the number of incontinence episodes per week. Changes from baseline in the number of voids per 24 hours and volume of urine per void were also evaluated. Exploratory analyses were conducted to determine whether particular subsets of patients showed differential responses to treatment. A total of 224 and 487 children (mean age 8 years) were randomized to placebo and tolterodine, respectively. Differences in the number of incontinence episodes per week, voids per 24 hours, and volume of urine per void between tolterodine and placebo did not reach statistical significance. This finding may be explained by a high placebo response and under dosage of tolterodine among children with greater body weight. Tolterodine was well tolerated. Analysis of the primary efficacy outcome did not reveal a statistically significant effect of treatment. However, secondary analyses demonstrated that tolterodine was well tolerated among 5 to 10-year-old children with diurnal incontinence. Exploratory analyses also showed that children weighing 35 kg or less with detrusor overactivity characterized by incontinence and/or frequent voiding benefited most from tolterodine treatment, suggesting that a weight adjusted dosing regimen may be required for optimal response among older and heavier children.

EFFICACY AND SAFETY OF OXYBUTYNIN IN CHILDREN WITH DETRUSOR HYPERREFLEXIA SECONDARY TO NEUROGENIC BLADDER DYSFUNCTION

We evaluated the efficacy and safety of oxybutynin in children with detrusor hyperreflexia due to neurological conditions. Study 1--A prospective, open label trial of 3 formulations of oxybutynin (tablets, syrup and extended release tablets) was conducted for 24 weeks in children 6 to 15 years old with detrusor hyperreflexia who used oxybutynin and clean intermittent catheterization. The effect of treatment on average urine volume per catheterization and on secondary urodynamic outcomes was evaluated. Study 2--The efficacy and safety of oxybutynin syrup were evaluated urodynamically in an open label study of children 1 to 5 years old with detrusor hyperreflexia who used oxybutynin and clean intermittent catheterization. Study 1--Mean urine volume per catheterization (+/- SEM) increased by 25.5 +/- 5.9 ml (p <0.001). Maximal cystometric capacity increased by 75.4 +/- 9.8 ml (p <0.001). Mean detrusor and intravesical pressures were significantly decreased by -9.2 +/- 2.3 (p < or =0.001) and -7.5 +/- 2.5 cm H2O (p <0.004), respectively, at week 24. Of 61 children with uninhibited detrusor contractions 15 cm H2O or greater at baseline 34 did not have them at week 24 (p <0.001). Improvements in bladder function were consistent across all oxybutynin formulations. Study 2--Mean maximal cystometric capacity increased significantly by 71.5 +/- 21.99 ml (p = 0.005). At study end only 12.5% of patients had uninhibited detrusor contractions 15 cm H2O or greater compared with 68.8% at baseline (p = 0.004). Oxybutynin was well tolerated in both studies. There were no serious treatment related adverse events. All 3 formulations of oxybutynin are safe and effective in children with neurogenic bladder dysfunction.

Preliminary study of the safety and efficacy of extended-release oxybutynin in children

Objectives. To test the safety and efficacy of extended-release oxybutynin in children with bladder dysfunction. The efficacy of oxybutynin in children has been limited by side effects. A new extended-release formulation of oxybutynin has some benefits versus traditional oxybutynin but has never been evaluated in children.Methods. A retrospective study was performed on 25 children who had been treated with extended-release oxybutynin. Fourteen had neurogenic bladder dysfunction and 11 had urinary frequency and urgency and urge incontinence but no neurologic abnormalities. Patients and families were asked to semiquantitatively (0 to 10 grading with 10 = severe) assess the effects of the medication on efficacy, as well as side effects and compliance with medication schedules.Results. All 25 patients had improvement in incontinence and/or voiding dysfunction on extended-release oxybutynin. Twelve (48%) experienced no side effects. Of the 13 who did, 10 complained of dry mouth (grade 4.6 ± 0.5), 4 had constipation (grade 5.8 ± 1.8), 4 had heat intolerance (grade 5.1 ± 0.9), and 3 had drowsiness (grade 5.3 ± 2.4). Of patients previously treated with oxybutynin, the extended-release oxybutynin was equally or more efficacious and had the same or fewer side effects, especially less dry mouth. Families reported much better patient compliance with the medication regimen using extended-release oxybutynin compared with oxybutynin. Patient and family satisfaction was very high, and 21 of 25 have continued using the medication.Conclusions. Extended-release oxybutynin is safe and efficacious in children. In this preliminary evaluation, it had benefits over traditional, immediate-release oxybutynin.

A SHORT-TERM, MULTICENTER, RANDOMIZED DOUBLE-BLIND DOSE TITRATION STUDY OF THE EFFICACY AND ANTICHOLINERGIC SIDE EFFECTS OF TRANSDERMAL COMPARED TO IMMEDIATE RELEASE ORAL OXYBUTYNIN TREATMENT OF PATIENTS WITH URGE URINARY INCONTINENCE

We compared the short-term efficacy, safety and tolerability of transdermal versus oral oxybutynin in adults with urge urinary incontinence. Volunteers with detrusor instability currently responding to oral immediate release oxybutynin were enrolled in our study. Those patients presenting with recurrence of incontinent symptoms after a 2-week washout underwent confirmatory cystometrogram with subsequent randomization to transdermal or oral treatment. Matching active and placebo medications included matrix patches applied twice weekly and capsules taken 2 or 3 times daily. Dose titration was based on anticholinergic symptoms. Outcome measures included comparison of baseline to 6 week changes in incontinence episodes on a 3 day urinary diary, a visual analog scale for efficacy and anticholinergic symptoms reported on a questionnaire. Safety monitoring included adverse events and skin tolerability of the transdermal system. A total of 76 patients were enrolled and 74 completed at least 4 weeks of treatment. Mean age in the transdermal and oral groups was 64 and 63 years, and 87% and 97% were female, respectively. Daily incontinent episodes decreased in the transdermal and oral groups (7.3 to 2.4 [66%] and 7.4 to 2.6 [72%], respectively, p = 0.39). The visual analog scale reduction in urinary leakage improved from washout in both groups (p <0.0001) with no difference between them (p = 0.9). Dry mouth occurred in significantly fewer patients in the transdermal (38%) compared with those in the oral group (94%, p <0.001). Of the patients in the transdermal group 67% noticed a reduction in dry mouth severity compared with previous oral treatment, and 90% had none or mild skin erythema. Transdermal delivery of oxybutynin resulted in comparable efficacy and a significantly improved anticholinergic side effect profile compared with oral administration in adults with urge urinary incontinence.

Combination Therapy of Imipramine with Oxybutynin in Children with Enuresis Nocturna

Purpose: The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna. Patients and Methods: This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998. Results: Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective. Conclusions: We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.

INTRAVESICAL OXYBUTYNIN FOR NEUROGENIC BLADDER DYSFUNCTION: LESS SYSTEMIC SIDE EFFECTS DUE TO REDUCED FIRST PASS METABOLISM

Purpose To unravel why intravesical oxybutynin is more effective and causes significantly fewer systemic side effects than oral oxybutynin in the treatment of neurogenic bladder dysfunction, we tested the hypothesis that the absorption and metabolism of oxybutynin are changed after intravesical instillation. Materials and Methods A high-performance liquid chromatography assay was developed for both oxybutynin and its active metabolite, N-desethyl-oxybutynin. Plasma concentrations were quantified after intravesical (n = 11) and oral (n = 5) administration of oxybutynin in children under steady-state conditions. Pharmacokinetic parameters were calculated. Results Oral administration of oxybutynin (0.2 mg./kg./dose) resulted in peak plasma concentrations for N-desethyl-oxybutynin which were 7.4 +/- 1.3 times higher than corresponding values for oxybutynin (n = 5). Also the AUC (area under the plasma concentration time curve) values were higher for N-desethyl-oxybutynin compared with those of oxybutynin, the ratio being 10.8 +/- 1.0 (n = 5). Intravesical instillation (0.2 mg./kg./dose), on the other hand, resulted in reduced metabolite generation and peak plasma concentrations for N-desethyl-oxybutynin which were in the same range as those for oxybutynin, the ratio being 1.2 +/- 0.1 (n = 11). The ratio for the AUC values for N-desethyl-oxybutynin and oxybutynin was 2.1 +/- 0.2 (n = 11). Conclusions The significantly lower AUC ratio of the N-desethyl metabolite over the mother compound, due to a reduced first pass metabolism, may explain the clinically relevant reduction of side effects that characterizes intravesical compared with oral oxybutynin therapy.

Epistaxis as a side effect of oxybutynin in children: Report of two cases

Epistaxis as a side effect of oxybutynin in children: Report of two cases