New strategies for medical management of overactive bladder in children.

The medical treatment of children with non-neurogenic overactive bladder syndrome (OAB) is still limited to a small number of drugs approved for use in childhood according to the national regulations of each country. Over the last few years, there were several studies on the use of antimuscarinics other than oxybutynin in children, as well as some on the use of extended release oxybutynin and tolterodine and transdermal oxybutynin. It was shown that the combination of two different anticholinergics might be a well tolerated and successful option in children with OAB refractory to monotherapy, as well as administration of a receptor-selective antimuscarinic such as solifenacin. European studies showed promising outcomes using propiverine, and good results were achieved in the majority of patients by injection of botulinum toxin into the detrusor. After exhaustion of conservative standard treatment (i.e. urotherapy), medical treatment should be considered for children with non-neurogenic OAB. Oxybutynin or off-label use of an agent that has been shown to be well tolerated and effective should be given preference over the use of medication that has not yet been evaluated in children. Randomized controlled studies on newer and receptor-selective anticholinergics, combination therapy, and botulinum toxin in children are needed.