Elsevier

Urology

Volume 68, Issue 4, October 2006, Pages 862-865
Urology

Pediatric urology
Improved efficacy of extended release oxybutynin in children with persistent daytime urinary incontinence converted from regular oxybutynin

https://doi.org/10.1016/j.urology.2006.04.034Get rights and content

Abstract

Objectives

To examine the response to conversion from regular oxybutynin (Ditropan) to an extended-release form (Ditropan XL) in children with persistent daytime urinary incontinence.

Methods

A retrospective review of patients with daytime wetting who switched from Ditropan to Ditropan XL included patient age, sex, reason for the change in medication, uroflowmetry findings before and after the change, side effects, and duration and dosage of the medication. The data were analyzed using a paired, two-tailed t test, with P <0.05 considered significant.

Results

Twenty-seven patients were followed up for an average of 35.8 months. A lack of improvement (n = 11), convenience (n = 6), side effects (n = 2), and a dislike of the taste (n = 2) were identified as reasons for changing to the extended release form. The mean dosage of Ditropan and Ditropan XL did not differ significantly (0.40 and 0.38 mg/kg/day, respectively). After the change to Ditropan XL, 6 patients had a resolution of side effects and 7 developed new side effects. Of the 27 patients, 13 became dry or had significant improvement by the first visit after the change to Ditropan XL. Significant increases in voided volume (38% versus 53%; P <0.01) and total bladder capacity (55% versus 70%; P = 0.03), normalized for age-expected bladder capacity, occurred by the first clinic visit after beginning Ditropan XL. No significant changes in the postvoid residual urine volume occurred.

Conclusions

The frequency of wetting decreased and the voided volume and bladder capacity increased after a change to Ditropan XL in children with persistent wetting when taking Ditropan.

Section snippets

Material and methods

An institutional review board-approved retrospective review of children diagnosed with daytime incontinence seen by one physician (C.S.C.) from 1999 through 2003 was undertaken to search for those taking either form of oxybutynin chloride (Ditropan or Ditropan XL, Ortho-McNeil, Raritan, NJ). Patients taking regular oxybutynin (Ditropan) who switched to the once-a-day, extended-release preparation (Ditropan XL) were included in the study. Patients were excluded from analysis if neurogenic

Results

A total of 27 patients met the inclusion criteria; 12 boys (average age 6.4 ± 0.9 years) and 15 girls (6.3 ± 1.5 years) were evaluated. Patients were followed up for an average of 35.8 ± 18.1 months. On average, the children took oxybutynin for 31.5 ± 18.9 months. The average duration of Ditropan use, preceding the change to Ditropan XL, was 11.6 ± 12.3 months. The average duration of Ditropan XL use was 19.9 ± 13.9 months, which constituted an average of 62.2% ± 23.2% of the entire time that

Comment

The number of studies comparing the use of Ditropan and Ditropan XL is quite limited. Two studies in adults found that immediate-release and extended-release oxybutynin had similar efficacy in reducing urge incontinence, although the extended-release preparation had a lower incidence of dry mouth.10, 11 Another study found that Ditropan XL significantly decreased the frequency of incontinent episodes, yet more than one half of the patients also experienced dry mouth as a side effect.12

The

Conclusions

Forty-eight percent of children with persistent daytime wetting when taking Ditropan became dry or had significant improvement when switched to Ditropan XL. Uroflow parameters also improved significantly after this change. A trial of Ditropan XL seems warranted in children with daytime wetting refractory to regular oxybutynin.

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