PURPOSE: Nocturia has been one of the most bothersome symptoms in benign prostatic hyperplasia (BPH) patients. Therefore, the authors evaluated the effect of tolterodine and oxybutyninin on nocturia in BPH patients. MATERIALS AND METHODS: From September 2006 to March 2007, 82 patients who presented over than 2 in nocturnal bladder capacity index (NCBI) in spite of having alpha blockers for 6 months were enrolled. Group I (n=38) took alpha blocker with tolterodine, group II (n=44) took alpha blocker with oxybutynin. The number of their nocturia episodes was separately evaluated by the time before and after the medication. The complications were assessed using a questionnaire. RESULTS: The number of nocturia episodes decreased by at least 1 in 68.4% (26/38), 84.1% (37/44) of patients in group I, II, respectively, and decreased by 2 or more, 1 and were unchanged or increased were 36.8, 31.6, 31.6% in group I patients and 45.5, 38.6, 15.9% in group II patients, respectively. In baseline nocturia > or =6 group, the nocturia decreased by 1 or more in 66.7%, 77.8% in group I, II, respectively. Adverse events, including dry mouth, dizziness, headache, etc, occurred in 21.1% (8/38) in group I and 27.3% (12/44) in group II patients. The complications between two groups showed no significant differences. CONCLUSIONS: Alpha blockers with tolterodine or oxybutynin can be effectively combined as a treatment option for patients with BPH complaining of unresolved nocturia.
Dizziness ; Headache ; Humans ; Mouth ; Nocturia* ; Prostatic Hyperplasia* ; Surveys and Questionnaires ; Urinary Bladder ; Tolterodine Tartrate

Overactive bladder is a chronic condition defined by bothersome urgency with or without urgency incontinence, usually associated with daytime frequency and nocturia. The treatment of this condition is to control bothersome urinary symptoms and is therefore to improve quality of life. The Korean Continence Society published the overactive bladder guideline in 2007, which suggested the mainstay of management is behavioral therapy and antimuscarinic pharmacotherapy. With growing awareness toward overactive bladder and quality of life, clinical information regarding antimuscarinic agents should be updated. There are several agents with good level of evidence and good grade of recommendation. Newer antimuscarinic agents are available or will be available in near future. The pharmacological properties, efficacy and tolerability of oxybutynin, trospium, propiverine, tolterodine, darifenacin, solifenacin, fesoterodine and imidafenacin are reviewed and discussed here. The results of major clinical studies are summarized.
Cholinergic Antagonists* ; Drug Therapy ; Muscarinic Antagonists ; Nocturia ; Quality of Life ; Urinary Bladder, Overactive* ; Solifenacin Succinate ; Tolterodine Tartrate

PURPOSE: There are few reports concerning the first-line treatment of choice for an overactive bladder. The aim of this study was to compare the effects of bladder training, tolterodine, and bladder training with tolterodine, as first-line treatments in patients with an overactive bladder. MATERIALS AND METHODS: A prospective randomized study was conducted on 99 female patients with overactive bladders. The patients were treated with bladder training, tolterodine (2mg twice daily), and bladder training with tolterodine, as first-line treatments, for 12 weeks. Of the 99 patients, 74 (bladder training: 24, tolterodine: 24, combined: 26) were followed up for 12 weeks. The treatment efficacy was measured by a micturition diary, subjective urgency scores and subjective perception of bladder condition at the end of the treatment. The safety and tolerability were assessed from adverse events and treatment withdrawals. RESULTS: After 12 weeks of treatment, the mean frequency of micturition and nocturia decreased by 27.1 and 55.8% in the bladder training group, 30.3 and 61.9% in the tolterodine group and 32.6 and 63.2% in the combined therapy group. The subjective mean urgency score decreased by 48.4, 62.5 and 63.2% in the three respective groups. The subjective perception of bladder symptom scores at the end of the treatments were 1.5, 1.42 and 1.31, with significant improvement rates of 50.0, 58.3 and 69.3% in the bladder training, tolterodine and combined therapy groups, respectively. Adverse events, and withdrawals due to adverse events, were 23.1 and 7.7% in the tolterodine and 28.6 and 7.1% in the combined therapy groups, but there were none in the bladder training group. CONCLUSIONS: Bladder training, tolterodine and combined therapy are all effective first-line treatments in female patients with overactive bladders. There are some enhanced effects with the combined therapy than with the bladder training and tolterodine monotherapies. Because of its high success rate, relatively low cost and absence of adverse events, bladder training should be included as a first-line treatment.
Female* ; Humans ; Nocturia ; Prospective Studies* ; Treatment Outcome ; Urinary Bladder* ; Urinary Bladder, Overactive* ; Urination ; Tolterodine Tartrate

PURPOSE: The incidence of overactive bladder (OAB) and the efficacy of alpha blocker and tolterodine combination therapy were examined in patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between March 2001 and December 2001, 144 BPH patients were subdivided into those with BPH, or BPH with OAB, based on urodynamic studies. All patients were treated with alpha blockers for 3 months. Patients with no symptomatic improvement were treated with alpha blockers and tolterodine for 2 months. An increase in the International prostate symptom scores (IPSS) of more than 3 points after medication was considered an improvement, but if not, as a failure. RESULTS: Of the 144 patients, 76 (53%) had BPH and 68 (47%) had BPH with OAB. The patients with BPH and OAB were older (p<0.05), but no differences were observed in the serum creatinine, IPSS, prostate volume, maximum flow rate or post-void residual urine (PVR) between the 2 groups. After 3 months treatment with alpha blockers, 79% (60/76) of the BPH and 35% (24/68) of the BPH with OAB patients had improved (p<0.05). Of the patients showing no improvement, 38% (6/16) with BPH and 73% (32/44) with BPH and OAB showed improvement after the addition of tolterodine. CONCLUSIONS: The combination therapy was more effective than alpha blockers alone in the treatment of patients with coexisting BPH and OAB. We recommend identifying these patients with an initial urodynamic study, which allows for the appropriate management and identification of those patients that may benefit from a more invasive treatment.
Creatinine ; Humans ; Incidence* ; Prostate ; Prostatic Hyperplasia* ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urodynamics ; Tolterodine Tartrate

PURPOSE: The aim of this study was to investigate the efficacy and adverse effects of oral tolterodine compared to oxybutynin in children with a neurogenic bladder. MATERIALS AND METHODS: 16 patients, with persistent daytime or nighttime wetting after oxybutynin medication for the treatment of a neurogenic bladder, were enrolled. All 16 patients had been crossed-over from oxybutynin to tolterodine due to serious side effects or lack of improvement. The mean age was 6.4 years (range 3 to 11), and the mean body weight was 22kg (range 16 to 33). All patients were initially treated with oral tolterodine, 2mg, twice daily. The efficacy of tolterodine was assessed in comparison to oxybutynin, and considered as improved with a greater than 50% reduction in wetting episodes, as stationary with a less than 50% reduction or as increased or aggravated with a greater than 50% increase. The tolerability was also assessed using a questionnaire for adverse events. RESULTS: The mean duration of tolterodine treatment was 193 days (range 14 to 940). After treatment with an initial tolterodine dose of 2mg bid, 5 patients (31%) were improved, 8 (50%) were stationary and 3 (19%) were aggravated. Overall, the initial tolterodine dose showed equal efficacy to that of oxybutynin (p=0.483). Of the 16 patients, side effects developed in 12 (75%) during the oxybutynin treatment, whereas only 2 (13%) developed side effects during the tolterodine treatment (p=0.001). CONCLUSIONS: Compared to oxybutynin, tolterodine was well tolerated in children, allowing greater compliance and offering an equally effective treatment for neurogenic incontinence in children with a neurogenic bladder. Therefore, it seems that tolterodine can be safely and effectively used to replace oxybutynin in children with a neurogenic bladder.
Body Weight ; Child* ; Compliance ; Humans ; Muscarinic Antagonists ; Surveys and Questionnaires ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Tolterodine Tartrate

PURPOSE: We evaluated the effects of amitiptyline, as one of the first-line therapies, on the nocturia of patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between June 2005 and December 2006, 50 patients completed this study(Group I=20, Group II=14, Group III=16). Group I was treated with doxazocin 4mg, group II was treated with doxazocin 4mg and tolterodine 4mg and the third group was treated with doxazocin 4mg and amitriptyline 10mg. We measured the treatment efficacy, the clinical parameters and we examined three days of the voiding diaries at baseline and after 4 weeks of treatment, respectively. RESULTS: After 4 weeks of treatment, all the patients had significant improvement for the International Prostate Symptom Score(IPSS) and the quality of life(QoL) score among the clinical parameters and they also showed improvement of their frequency of micturition per 24 hours, per night(nocturnal frequency) among the voiding diary parameters(p<0.05). For the post-treatment comparison of the nocturnal frequency, there was a significant difference between group I and group II as well as between group I and group III(p<0.05), and there was no difference between group II and group III(p>0.05). Although there was 1 case of mild dry-mouth in group II and 1 case of mild dry-mouth and drowsiness in group III, none of the patient dropped out due to side effects. CONCLUSIONS: We found significant improvement in the IPSS, the QoL score and the nocturnal frequency after treatment with amitriptyline 10mg. Therefore, amitriptyline 10mg would be helpful as a first-line therapy for BPH patients with nocturia.
Amitriptyline ; Benzhydryl Compounds ; Cresols ; Humans ; Nocturia ; Phenylpropanolamine ; Prostate ; Prostatic Hyperplasia ; Sleep Stages ; Treatment Outcome ; Urination ; Tolterodine Tartrate

PURPOSE: We investigated the effect of oral or intravenous tolterodine on cystometric parameters in awake spontaneously hypertensive rats (SHRs) as a model of overactive bladder (OAB). The aim of our study was to observe the experimental conditions required to reproduce the clinical pharmacological effects of tolterodine, as seen in humans, to decrease bladder pressure or increase bladder capacity. MATERIALS AND METHODS: We studied the effects of the most widely used antimuscarinic drug, tolterodine, on cystometric parameters via two different administrations (oral and intravenous) in awake SHRs. RESULTS: Oral administration of tolterodine 10 mg/kg(-1) body weight in awake rats did not change any cystometric parameters significantly. Intravenous administration of tolterodine 0.3 mg/kg(-1) body weight significantly decreased basal pressure (BP) and micturition pressure (MP), but showed no effect on micturition interval (MI) or bladder capacity (BC). CONCLUSION: Despite a high dose of tolterodine via an oral or an intravenous route, a decrease in BP or MP was the only effect on cystometrographic parameters in awake rats, whereas MI and BC were not significantly affected. Therefore, it is difficult to reproduce in awake rats as an acute response the cystometric increase in the MI that is observed in humans after chronic administration of antimuscarinic agents.
Administration, Intravenous* ; Administration, Oral ; Animals ; Body Weight ; Humans ; Muscarinic Antagonists ; Rats ; Rats, Inbred SHR* ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urination ; Tolterodine Tartrate

PURPOSE: To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. MATERIALS AND METHODS: Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. RESULTS: In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. CONCLUSIONS: Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.
Adrenergic alpha-Antagonists ; Analgesics ; Benzhydryl Compounds ; Cholinergic Antagonists ; Cresols ; Humans ; Lower Urinary Tract Symptoms ; Phenylpropanolamine ; Prospective Studies ; Prostate ; Stents ; Sulfonamides ; Ureter ; Ureteroscopy ; Urinary Catheterization ; Urological Manifestations ; Tolterodine Tartrate

PUROPOSE: It is known that anticholinergics induces cognitive dysfunction and may aggravate the state of it. Tolterodine tartrate (detrusitol(R)) is a widely known selective anticholinergics to bladder, which does not cause a cognitive dysfunction. This study was designed to analyze the change of cognitive function of brain disease patients, whom are taking anticholinesterase inhibitor with tolterodine for overactive bladder (OAB). MATERIAL AND METHODS: From January 2001 to December 2004, with the patients whom have been followed for the brain disease in the department of neurology, we have analyzed 79 patients with tolterodine administered for OAB. We used K-MMSE (Korea minimental status examination) and SNSB (seoul neuropsychological screening battery) to analyze the state of cognition. Mean age of patients was 67.3+/-4.5 (yrs), mean administration period was 4.7+/-9.5 (mon). RESULTS: 7 patients made complaints for the decline of memory, 2 of them with Parkinsonism and 2 with cerebral infarction, 1 with progressive supranuclear palsy and, 2 dementia with lewy body (DLB). Patients with DLB was excluded in this study because the disease had fluctuation of cognitive function. CONCLUSIONS: The result of these studies demonstrates tolterodine tartrate caused the decline of cognitive function in only a few patients with brain disease. We concluded that prospective studies are needed to change the cognitive functions of the brain disease patients with OAB after administration of tolterodine tartrate.
Brain Diseases* ; Cerebral Infarction ; Cholinergic Antagonists ; Cognition ; Dementia ; Humans ; Lewy Bodies ; Mass Screening ; Memory ; Neurology ; Parkinsonian Disorders ; Supranuclear Palsy, Progressive ; Urinary Bladder ; Urinary Bladder, Overactive* ; Tolterodine Tartrate

PURPOSE: Benign prostatic hyperplasia(BPH) patients usually accompanies overactive bladder(OAB) symptoms. Adding anticholinergics in these patients evokes us worrying about deterioration of obstructive symptoms. We evaluated the relative benefit of anticholinergics compared with alpha-blocker only group in terms of emptying efficiency and storing symptoms. MATERIALS AND METHODS: From October 2000 to February 2006, male LUTS(lower urinary tract symptoms) patients with more than 8 IPSS(international prostate symptom score) and more than 2 score in IPSS urgency question(question 4) were selected. 168 patients were eligible without exclusion criteria or drop-out and with follow-up. In 109 patients, alpha-blocker plus anti-cholinergic were used(group I) and in 59 patients alpha-blocker only(group II). Used anti-cholinergics were tolterodine 1 mg, 2 mg and propiverine 10 mg, 20 mg. After mean 15.3 months, follow up evaluation was done. IPSS score was divided as emptying domain(question 1,3,5,6) and storing domain(question 2,4,7). Between the 2 groups the amount of change in each domain of IPSS, urgency question score, total IPSS, QoL, uroflowmetry and RU were compared. According to used anticholinergic and dosage 4 divided groups were also compared as the same methods. RESULTS: The mean age was 64.7+/-9.8 years. Baseline characteristics between the 2 groups were not different in all parameters. After mean 15.3 months later, the changes of storing symptom domain score were -3.3+/-2.7, -2.4+/-2.5 for group I and group II respectively(p=0.041) and urgency question score -1.6+/-1.4, -1.1+/-1.2 (p=0.046) and quality of life score -0.7+/-1.2, -0.4+/-0.8(p=0.028). But the changes of all other parameters were not different between 2 groups. Subdivided 4 cholinergic groups didn't show any differences among groups. CONCLUSIONS: Combination of alpha-blockers with anticholinergics in benign prostatic hyperplasia with overactive bladder patients seems not to lower emptying efficiency significantly but improve storing symptoms significantly.
Cholinergic Antagonists* ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Urinary Bladder, Overactive* ; Urinary Tract ; Tolterodine Tartrate