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At least 1,513 records · Page 84Linked to original sources
PubMed2005

Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study.

PURPOSE: We determined the safety and efficacy of each of 2 doses of botulinum toxin type A (BTX-A) (200 or 300 U BOTOX) injected into the detrusor for urinary incontinence caused by neurogenic detrusor overactivity of predominantly spinal cord origin. MATERIALS AND METHODS: A total of 59 patients with urinary incontinence caused by neurogenic detrusor overactivity (due to spinal cord injury in 53 and multiple sclerosis in 6) requiring clean intermittent self-catheterization were randomized to receive a single dose into the detrusor of BTX-A (200 U or 300 U) or placebo. Changes in daily frequency of urinary incontinence episodes were monitored via a patient bladder diary during 24 weeks. Key urodynamic assessments (maximum cystometric capacity, reflex detrusor volume and maximum detrusor pressure during bladder contraction) were used to provide objective measures of the treatment effect on bladder function. The impact of treatment on quality of life was assessed using the Incontinence Quality of Life questionnaire. RESULTS: There were significant posttreatment decreases in incontinence episodes from baseline in the 2 BTX-A groups (p </=0.05) but not in the placebo group. In addition, more patients who received BTX-A reported no incontinence episodes during at least 1 posttreatment evaluation period. Positive treatment effects were also reflected by significant improvements in bladder function in the BTX-A groups, as assessed by urodynamics and in patient quality of life. Benefits were observed from the first evaluation at week 2 to the end of the 24-week study. No safety concerns were raised. CONCLUSIONS: Intramuscular injections of BTX-A into the detrusor can provide rapid, well tolerated, clinically significant decreases in the signs and symptoms of urinary incontinence caused by neurogenic detrusor overactivity during a 24-week study period.

Adult↗
PubMed2005

Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity.

PURPOSE: Botulinum neurotoxin type A (BoNT/A) is effective in the treatment of intractable detrusor overactivity (DO). In addition to its known inhibitory effect on presynaptic release of acetylcholine by motor terminals, there is increasing evidence that BoNT/A may affect sensory fibers. We investigated a possible effect of BoNT/A on human bladder afferent mechanisms by studying the sensory receptors P2X3 and TRPV1 in biopsies from patients with neurogenic or idiopathic DO. MATERIALS AND METHODS: A total of 38 patients (22 with neurogenic DO, 16 with idiopathic DO) with intractable DO were treated with intradetrusor BoNT/A, and bladder biopsies were taken at 4 and 16 weeks. Urodynamics and voiding diary were also recorded. Specimens were studied immunohistochemically for P2X3, TRPV1 and the pan-neuronal marker PGP9.5, in comparison with controls. RESULTS: P2X3-immunoreactive and TRPV1-immunoreactive (-IR) fibers were decreased at 4 weeks after BoNT/A, and more significantly at 16 weeks (paired t test p=0.0004 and p=0.0008, respectively), when significant improvements were observed in clinical and urodynamic parameters. P2X3-IR fiber decrease was significantly correlated with reduction of urgency episodes at 4 and 16 weeks (p=0.0013 at 4 weeks and p=0.02 at 16 weeks), but not maximum cystometric capacity or detrusor pressures. TRPV1-IR fiber decrease showed a similar trend. PGP9.5-IR suburothelial fibers remained unchanged after treatment at both followups (p=0.85 and p=0.21 at 4 and 16 weeks, respectively). Urothelial cell P2X3-IR and TRPV1-IR also appeared unchanged. CONCLUSIONS: Decreased levels of sensory receptors P2X3 and/or TRPV1 may contribute to the clinical effect of BoNT/A in detrusor overactivity.

Adult↗
PubMed1996

Agents for the treatment of overactive detrusor. V. Synthesis and inhibitory activity on detrusor contraction of N-tert-butyl-4,4-diphenyl-2-cyclopentenylamine.

N-tert-Butyl-4,4-diphenyl-2-cyclopentenylamine ((+/-)-3) was designed to restrict the conformation of terodiline 1 and was synthesized in a 6-step approach starting with diphenylacetaldehyde (10) or in a 4-step approach starting with 2,2-diphenyl-4-pentenoic acid (17). Using di-p-toluoyltartaric acid as a resolving agent, the synthetic (+/-)-3 was resolved into its optically pure forms, (-)- and (+)-3. The (-)-enantiomer (-)-3.HCl (FK584) showed about ten times more potent inhibitory activity on urinary bladder rhythmic contraction in rats (ED30 = 0.18 mg/kg, i.v.) than terodiline (ED30 = 1.9 mg/kg, i.v.), while the (+)-enantiomer (+)-3.HCl showed no inhibitory activity at 1.0 mg/kg i.v. Compound (-)-3.HCl (FK584) has pharmacological properties similar to those of terodiline, as evaluated by in vitro assay and is currently in clinical development for the treatment of overactive detrusor.

Amines↗
PubMed2006

Partial urethral obstruction enhances NADPH-diaphorase activity in the monkey (Macaca fascicularis) bladder: light and electron microscopic studies.

The effect of partially obstructing the urethra on the nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) activity in neurons of the intramural ganglia of the monkey (Macaca fascicularis) bladder was examined by light and electron microscopy. Partial urethral ligation was done in adult male monkeys. The animals were sacrificed 2, 4 weeks after partial urethral obstruction. This was compared to controls (normal and sham operated). Urethral obstructed animals were observed to have increased urinary frequency and decreased urinary flow rate. Two weeks after urethral obstruction, the overall NADPH-d activity in the intramural ganglia of the bladder base was enhanced compared to control animals. The frequency of intensely stained NADPH-d positive neurons was increased compared to the control animals. About one-third of intensely stained NADPH-d positive neurons appeared to undergo degenerative changes. At 4 weeks after urethral obstruction, a wide occurrence of NADPH-d positive neurons in advanced stages of degeneration in the bladder base was observed. Cellular debris was strewn among normal looking ganglion cells and along the nerve processes. The proportion of intensely stained NADPH-d positive neurons was relatively lower than the controls. The total number of NADPH-d positive neurons and the nerve fibres in the entire bladder was significantly reduced when compared to control animals. Electron microscopy showed some NADPH-d activity in intramural ganglion cells in 2 weeks after partial urethral obstruction. NADPH-d reaction product (formazan) was deposited on the membranes of the rough endoplasmic reticulum, and the outer membranes of some mitochondria in the intramural neuron. At 4 weeks after urethral obstruction, NADPH-d was present in the membrane of the mitochondria and some mitochondria appeared swollen with disrupted cristae. Present results show that NADPH-d activity in neurons of the intramural ganglia of the monkey (Macaca fascicularis) urinary bladder was increased after two weeks and reduced after 4 weeks of partial urethral obstruction. It is speculated that the increased NADPH-d activity associated with partial urethral obstruction would lead to neuronal damage and death, which may contribute to detrusor overactivity. However, it warrants further investigation to understand the mechanism of neuronal cell death after partial urethral obstruction.

Animals↗
PubMed1999

[Urinary disturbance in olivopontocerebellar atrophy (OPCA)--changes during the progression of the disease].

PURPOSE: Among spinocerebellar degeneration, syndromes categorized as multiple system atrophy (MSA) are commonly associated with neurogenic bladder, and urinary disturbances change with the disease progression. Accordingly, the changes in the urodynamic findings during the progression of the disease have been studied in the case of Olivopontocerebellar atrophy (OPCA) and OPCA type of MSA. METHODS: Urodynamic study (UDS) was performed more than twice in eight patients (5 males, 3 females, age 48-76, mean 55.0). The interval range between the first examination and follow up examination was 9-93 months (mean 42.4). UDS included cystogram, intravenous pyelography, residual urine volume, cystometry, urethral pressure profilometry, and external sphincter electromyography. RESULTS: The bladder was deformed in almost all patients with the progression of the disease, but the upper urinary tract was properly preserved. Residual urine volume tended to increase, and residual urine rate worsened significantly. The stable detrusor activity seemed to become overactive accompanied by detorusor hyperreflexia, and finally seemed to be acontractile. The normal sphincter activity seemed to become overactive accompanied by detrusor-sphincter dyssynergia, and finally complete relaxation could't be observed. CONCLUSION: These results suggest that urinary disturbance deteriorates together with other neuropathies as the disease progresses in OPCA. These patients should be continuously observed along with proper urinary management depending on the disease progression.

Aged↗
PubMed2003

Structural basis of neurogenic bladder dysfunction. I. Methods of prospective ultrastructural study and overview of the findings.

PURPOSE: We standardize procedures for ultrastructural study of detrusor smooth muscle and intrinsic nerves in neurogenic bladder dysfunction in the human, and present an overview of the findings. MATERIALS AND METHODS: The study included 18 female and 33 male patients 7 to 96 years old. They had neurogenic bladder dysfunction with hyperreflexia for less than 1 to 43 years, resulting from upper motoneuron lesions (spinal cord injury 25, brain disorder 17) or combined upper and lower motoneuron deficit (meningomyelocele 9). Endoscopic or open bladder biopsies were processed for ultrastructural study of detrusor smooth muscle and intrinsic neural elements. Qualitative morphologic criteria of muscle cell arrangement, degeneration and cell-cell contacts, as well as those of degeneration and regeneration of intrinsic neural elements are defined. RESULTS: Five biopsies from the brain disorder group had insufficient smooth muscle and were excluded from study. The remaining 46 biopsies were evaluated by electron microscopy, and all displayed the complete dysjunction pattern of detrusor overactivity. Most displayed degeneration and regeneration of intrinsic axons but disproportionately limited muscle cell degeneration, irrespective of detrusor contractility. The brain disorder group biopsies displayed many more ultrastructurally normal axons than the meningomyelocele and spinal cord injury group biopsies (median 33% versus 8% or less). CONCLUSIONS: Upper motoneuron neurogenic bladder dysfunction in humans is associated with intrinsic neuromuscular defects in the detrusor. Ultrastructural features of these defects suggest morphologic markers that not only may distinguish neuropathic from nonneuropathic bladder dysfunction, but also may point to the anatomical level of the neurogenic deficit.

Adolescent↗
PubMed1984

Clinical correlation of urodynamic findings in patients with localized partial lesions of the spinal cord and cauda equina.

Urodynamic studies were undertaken in 70 patients with incomplete, confirmed, localized lesions involving the spinal cord and cauda equina, irrespective of clinically evident bladder disturbances. Both detrusor and urethral function were simultaneously evaluated and correlated with neurological deficits and symptoms of lower urinary tract dysfunction. It was evident that in those patients with localized spinal cord lesions, lower urinary tract disturbances were closely associated with disturbances of pinprick sensation. Clinically silent bladder and sphincter dysfunction was encountered in 14% of the patients, and the number of asymptomatic patients was significantly higher among those with upper motor neuron lesions. Incontinence was associated predominantly with conus lesions; however, the other symptoms had no relationship to the site of the lesion. Symptoms such as urgency, incontinence, and nocturnal incontinence were associated with detrusor hyperactivity, and urinary retention was associated with urethral overactivity and dyssynergia. The urodynamic findings could explain the pathogenesis of the symptoms in most instances, but were not necessarily related to them. It is concluded that the pathways subserving lower-urinary-tract function are closely associated with the pathways subserving pinprick sensation, and that a lesion along the spinal axis can affect the bladder, sphincter, or both in a variety of ways, thus leading to the widely variable clinical findings associated with neurogenic lower urinary tract dysfunction.

Adult↗
PubMed2004

New therapeutic options for refractory neurogenic detrusor overactivity.

AIM: Current pharmacologic treatment of detrusor overactivity relies on anticholinergic drugs. However, they often have untolerable side effects so that they are administered in doses insufficient to restore urinary continence. Recently, intravesical instillations and injections into the detrusor muscle of new pharmacological agents have been developed. The present study report our own experience in the treatment of detrusor overactivity with intravesical administrations of vanilloid agents and with botulinum-A toxin injections into the detrusor muscle in a group of spinal cord injured patients. In particular, we compared the clinical and urodynamic effects of the 2 drugs in an attempt to find a new and valid therapeutic option in those cases unresponsive to conventional treatment. METHODS: Seventy-five patients with spinal cord injury and refractory detrusor overactivity were included in the study: 35 patients received repeated intravesical instillations of resiniferatoxin (RTX) dissolved in normal saline; 40 patients received repeated injections of 300 units botulinum A-toxin diluted in 30 ml normal saline. Clinical assessment and urodynamics were performed at baseline and 6, 12 and 24 months after treatment. RESULTS: With both treatments there was a significant reduction in mean catheterization and episodes of incontinence and a significant increase in mean first involuntary detrusor contraction and in mean maximum bladder capacity at 6, 12 and 24 months after therapy. We did not detect any local side effects with either treatment. Botulinum-A toxin significantly reduced also the maximum pressure of uninhibited detrusor contractions more than RTX at all follow-up time points. CONCLUSION: In patients with spinal cord injury and refractory detrusor overactivity intravesical RTX and botulinum-A toxin injections into the detrusor muscle provided beneficial clinical and urodynamic results with reduction of detrusor overactivity and restoration of urinary continence in most patients. Botulinum-A toxin injection provided better clinical and urodynamic benefits than intravesical RTX.

Administration, Intravesical↗
PubMed1994

Agents for the treatment of overactive detrusor. VII. Synthesis and pharmacological properties of 2,3- and 3,4-diphenylcyclopentylamines, 2,3-diphenyl-2-cyclopentenylamines, and related compounds.

As part of our search for new agents for the treatment of overactive detrusor, 2,3- and 3,4-diphenylcyclopentylamines (3), 2,3-diphenyl-2-cyclopentenylamines (4), and related compounds (5 and 18) were synthesized and evaluated for inhibitory activity (i.v.) against urinary bladder rhythmic contraction in rats. Among them, some compounds involving N-tert-butyl-2,3-diphenyl-2-cyclopentenylamine (4b) exhibited inhibitory activity against bladder contraction superior to that of terodiline (2). Mydriatic activity (i.v.) of compound 4b in rats, an index of its side effects due to antimuscarinic activity, was found to be relatively weak in comparison with its inhibitory activity against bladder contraction. The pharmacological profile of 4b was examined in comparison with that of terodiline. Most of the objective amines (3, 4, 5) were synthesized by preparation of Schiff bases from the corresponding cyclic ketones (6, 7, 8) and amines in the presence of TiCl4 in CH2Cl2 and subsequent reduction with NaBH4 in the presence of MeOH in one pot (method A).

Amines↗
PubMed1997

Emptying against outflow obstruction--pharmacological aspects.

Outflow obstruction induces changes in muscarinic and adrenergic receptor functions, and in non-adrenergic, non-cholinergic (NANC) mechanisms relevant for detrusor contraction and relaxation. The complexity of the muscarinic regulation of detrusor function makes the relative importance of the different muscarinic receptor subtypes difficult to assess, both in the normal and obstructed detrusor. This means that the optimal profile of subtype selectivity of antimuscarinic drugs meant for treatment of detrusor overactivity still remains to be established. In most animal species, detrusor contraction is mediated by both muscarinic and NANC mechanisms. The most likely transmitter responsible for the NANC-component of contraction is ATP. NANC-components are probably of minor importance in the normal human detrusor. However, if the importance of the ATP-dependent component of contraction increases in the obstructed detrusor, this may have therapeutic implications. In normal human detrusor, alpha-adrenoceptors seem to have no significant role in the contractile activation. However, the effectiveness of alpha-adrenoceptor antagonists on storage symptoms, and, occasionally, on urodynamically proven detrusor instability, in patients with outflow obstruction, suggests an involvement of alpha-adrenoceptors. The functional importance of beta-adrenoceptors for the obstructed detrusor function remains to be settled. In outflow obstruction, changes in the excitability of the detrusor smooth muscle may occur that predisposes for detrusor overactivity. Drugs acting at K+ channels can decrease detrusor excitability, and may, if cardiovascular side effects can be avoided, represent a novel, promising way of treating detrusor overactivity.

Adenosine Triphosphate↗
PubMed2005

The effect of penile vibratory stimulation on male fertility potential, spasticity and neurogenic detrusor overactivity in spinal cord lesioned individuals.

PURPOSE: Present the possibility for treatment of male infertility, spasticity, and neurogenic detrusor overactivity in spinal cord lesioned (SCL) individuals with penile vibratory stimulation (PVS). METHOD: Obtaining reflex-ejaculation by PVS, by using a vibrator developed for this purpose. The stimulation was performed with a vibrating disc of hard plastic placed against the frenulum of the penis (amplitude > or = 2.5 mm). The vibration continued until antegrade ejaculation or for a maximum of 3 minutes followed by a pause of 1 minute before the cycle was repeated, maximally 4 times. RESULTS: >80% SCL men are able to obtain ejaculation with PVS. Pregnancy rates obtained with home PVS and intra-vaginal insemination was 22-62% (4 studies), and with PVS or electroejaculation and intrauterine insemination/in-vitro fertilization/intracytoplasmatic sperm injection 39-64% (9 studies). PVS was demonstrated to decrease spasticity significantly when measured by the modified Ashworth scale. In addition, a decrease of the number of spontaneous EMG events which probably indicate spasms was observed. Increase in bladder capacity at leakpoint following 4 weeks of frequent ejaculation with PVS treatment was likewise demonstrated. CONCLUSION: PVS has proved its importance for SCL male fertility, in the years to come its place in treatment of spasticity and neurogenic detrusor overactivity has to be established.

Humans↗
PubMed2004

Nocturnal enuresis in older adults.

BACKGROUND: Nocturnal enuresis is uncommon in older adults. The paucity of literature about this problem prompts us to review our cases to determine the management strategy. METHODS: Six older adults, including 2 females and 4 males, were evaluated for refractory nocturnal enuresis. Only 2 of them had minor daytime urge symptom. Most of them had failed in the treatment using anticholinergics and/or alpha-adrenergic blocker. Evaluation consisted of detailed medical history, voiding diary, and urodynamic studies. Clinical follow-up persisted for 12 months. We define nocturnal polyuria as nighttime urine amount being more than 35% of total daily urine amount. Bladder outlet obstruction in men was diagnosed based on the definition described by International Continence Society. RESULTS: The average age was 71 years (range 61-84). The average duration of the symptom was 3.1 months (range 0.5-6). Two patients had bladder outlet obstruction. Four patients used hypnotics for insomnia, which might result in difficult awakening on bladder distension. Nocturnal polyuria was found in 3 patients. Most patients had multiple factors contributing to their nocturnal enuresis except 1, who was found to have an enlarged prostate with chronic bladder distension. Specific treatments were given based on the causes for each patient. Hypnotics were discontinued for a certain meanwhile in some patients. Nocturnal polyuria was managed with afternoon diuretic or bedtime desmopressin. Bedtime anticholinergic agent was used in patients with detrusor overactivity. The patient with enlarged prostate and urinary retention was managed with indwelling catheter followed by elective transurethral prostatectomy. All patients were dry in the night following the treatment. CONCLUSIONS: Nocturnal enuresis in older adult is usually multi-factorial. Hypnotic usage and nocturnal polyuria are frequently overlooked. Detailed investigation is necessary to identify the causes. Tailored treatment may achieve satisfactory results.

Aged↗
PubMed2004

Botulinum toxin in urology: evaluation using an evidence-based medicine approach.

Clinical reports documenting the beneficial effects of botulinum toxin (BTX) to treat various lower urinary tract disorders of muscle spasticity (e.g. detrusor hyperreflexia, detrusor sphincter dyssynergia) have led to its expanded application in non-neurogenic conditions such as idiopathic detrusor overactivity, detrusor underactivity and benign prostatic hyperplasia (BPH). As greater numbers of investigators report their results utilizing this agent, it becomes more important that clinicians are able to synthesize and describe the findings of current clinical studies in a meaningful way. Evidence-based medicine is a platform on which investigations concerning a particular topic can be evaluated for their levels of scientific evidence, so that rational clinical recommendations can be formulated. This review article applies evidence-based practices to the use of BTX in common urologic conditions. Appreciating the benefits as well as limitations of currently available studies will hopefully drive the development of well-controlled, randomized studies of BTX, particularly in highly prevalent conditions such as idiopathic detrusor overactivity and BPH.

Botulinum Toxins↗
PubMed2005

Multiple intravesical instillation of low-dose resiniferatoxin is effective in the treatment of detrusor overactivity refractory to anticholinergics.

OBJECTIVE: To examine the effectiveness and tolerability of multiple intravesical instillations of 10 nmol/L resiniferatoxin in patients with detrusor overactivity (DO) refractory to anticholinergic agents, as not all these patients are successfully treated by one such instillation. PATIENTS AND METHODS: The study included 53 patients with DO from neurogenic (NDO, 10), previous bladder outlet obstruction (BOO, 20) or idiopathic cause (IDO, 23) and who were refractory to anticholinergic agents. Patients received three to four instillations of 10 nmol/L resiniferatoxin, as outpatients. The International Prostate Symptom Score and quality-of-life index were recorded, and a video-urodynamic study conducted at baseline and 3 months after treatment. The therapeutic results and urodynamic variables were compared among patients with different causes of DO. RESULTS: Four patients withdrew from the study after the first instillation because of urinary tract infection or severe pain on urination, leaving 49 who completed at least three instillations. The overall results were an excellent response in 17 patients (35%), improvement in 13 (27%) and failure in 19 (39%); the treatment was deemed a success (excellent or improved) in 16 of 20 with previous BOO, 11 of 19 with IDO, and only three of 10 with NDO (P = 0.011). Patients had significant improvements in the storage symptom score, total symptom score and quality-of-life index after treatment. The cystometric capacity and the postvoid residual were significantly greater and voiding efficiency significantly less after treatment. DO during the urodynamic study was absent in 12 patients after treatment. CONCLUSIONS: Multiple intravesical instillations of 10 nmol/L resiniferatoxin are effective in treating patients with DO refractory to anticholinergics.

Administration, Intravesical↗
PubMed2001

Inhibition of the contractile responses of isolated human and rat bladders by clenbuterol.

PURPOSE: We investigated the inhibition of the contractile responses of human continent and unstable detrusor muscle by the beta2 agonist clenbuterol as well as the inhibition of electrical field stimulation evoked contractile responses of isolated rat bladder muscle strips by orally administered clenbuterol. MATERIALS AND METHODS: The contractile responses of human continent and unstable detrusor muscle strips to electrical field stimulation (0.05 milliseconds, 0.5 to 80 Hz.) were measured before and after adding 10(-9) to 10(-4) M. clenbuterol in vitro. In addition, 6 rats per group were dosed orally with 2 microg x kg(-1) clenbuterol daily acutely (1 dose) or chronically (1 dose daily for 8 days), or with distilled water to serve as controls. The contractile response to electrical field stimulation of strips of isolated detrusor muscle was then measured. Serum clenbuterol levels were analyzed in duplicate by enzyme-linked immunosorbent assay and high performance liquid chromatography. RESULTS: In vitro clenbuterol significantly inhibited the electrical field stimulation evoked contractile responses of detrusor muscle strips from unstable but not continent human bladders. A significant inhibitory effect of clenbuterol on the electrical field stimulation evoked contractile response of rat detrusor muscle was observed after chronic but not acute oral dosing (p <0.01). Serum clenbuterol levels measured by enzyme-linked immunosorbent assay and high performance liquid chromatography were not significantly different. CONCLUSIONS: Clenbuterol or related beta2-adrenoceptor agonists may represent a useful therapeutic strategy for detrusor muscle overactivity.

Adrenergic beta-Agonists↗
PubMed2004

Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children.

Idiopathic or "functional" urinary incontinence in children--incontinence with no known neurologic or anatomic cause--may take the form of urge incontinence, the most common type of incontinence, which is characterized by detrusor overactivity during the filling phase, or dysfunctional voiding. The latter may be classified as staccato voiding (periodic bursts of pelvic floor activity with prolonged voiding and, in some cases, residual urine), interrupted voiding (insufficient bladder emptying, infrequent voiding with several phases of micturition), or "lazy bladder" syndrome (infrequent voiding and large bladder capacity). The etiology of functional incontinence is unknown. Theories include genetic predisposition, recurrent urinary tract infections, immaturity or too-early toilet training, and sexual abuse. A severe form of urge incontinence, nonneurogenic neurogenic (Hinman) bladder, may be the end stage of dysfunctional voiding, but an occult neurologic component should also be considered. Diagnostic procedures recommended for children with urinary incontinence include careful history taking, a voiding diary, and physical examination to identify symptoms and to minimize the need for invasive procedures. Treatments include behavioral modification, biofeedback, antibiotics, anticholinergics, counseling, and neuromodulation. The antimuscarinics oxybutynin and tolterodine are, at present, the most commonly used drugs to treat incontinence. Common side effects with these agents (ie, reduced saliva production and worsening constipation) can be severe and can cause up to 10% of children using oxybutynin to discontinue treatment. Current evidence suggests that tolterodine may have a more favorable safety profile than oxybutynin. In addition, new antimuscarinics in the pipeline, eg, darifenacin and solifenacin, are expected to possess more favorable safety and tolerability profiles and may therefore help to alleviate these limitations.

Child↗