ABSTRACT

In neuro-urological practice the immediate release oxybutynin - the extended release one has become available in Italy only in 2010 - is usually considered more effective than the immediate release tolterodine in the treatment of overactive bladder caused by spinal cord injury. But in literature there is no a clear evidence, mainly for lack of papers on this topic.

We reviewed records of patients with spinal cord injury from January 1996 and June 2009. We found 16 patients (11 males and 5 females, mean age 43.5 years, range 22-67) that switched the antimuscarinic treatment from one drug to the other one having been checked by videourodynamic examinations during the assumption of each drug. The drugs were assumed at the usual dosages (tolterodine 2 mg twice a day and oxybutinin 5 mg twice or three times a day with an average of 12.5 mg). The efficacy of the antimuscarinics has been estimated clinically, based on the micturition diaries, and instrumentally, based on the modifications of the urodynamic parameters. Oxybutynin has resulted more effective than tolterodine at the recommended dosage for 75% of patients with detrusor-sphincter dyssinergy caused by sovrasacral spinal cord injury. Videourodynamic studies showed an increase of cystometric bladder capacity and a decrease of detrusor pressure in comparison with tolterodine. The statistical comparison between the two averages relative to maximal detrusor pressure and bladder cystometric capacity determined by using the “Student test for data joined to a tail” has turned out meaningful for p<0,01.