Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children's development. From the patient's perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures.Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.

Pessary use is a feasible and acceptable treatment option for the long-term management of symptomatic prolapse in over 60 % of all women aged 65 years and older.

Introduction: Overactive bladder (OAB) symptoms are complex and generally require long-term therapy. Nevertheless, it has been demonstrated that persistence rates of antimuscarinic drug use are low in adults. Better understanding of the treatment patterns of children treated with antimuscarinics could help to improve drug management. Our objective was to evaluate persistence rates of patients under 20 years of age on antimuscarinic therapy over a four-year period. Methods: Patients having received a first-ever antimuscarinic drug prescription between April 2007 and March 2008 were identified using IMS Brogan's Public and Private Drug Plans database. Canadian drug claims data from Private Drug Plans, Régie de l'Assurance Maladie du Québec, and Ontario Public Drug Plans were analyzed retrospectively. Patients were followed for four years to assess the prescribed drugs, the lines of treatment, and the duration of each treatment. Results: Data were available for 374 patients. The most prescribed drug as a first-line therapy was oxybutynin (87.2%), followed by tolterodine LA (5.9%). Patients refilled their index prescriptions for an average of 429 days. Solifenacin had the highest mean duration of index therapy (765 days). The median number of antimuscarinics prescribed was one. At the end of the followup, 44 patients were still on therapy. Reasons for discontinuation of treatment were not available. Conclusions: Overall discontinuation rate of antimuscarinic therapy in children is comparable to what has been reported in adult patients with OAB. However, children seem to persist on the medication for a longer duration before adherence rates start declining. The low rate of persistence highlights the need to identify the reasons for discontinuation of therapy in children in order to obtain better persistence rates.

The success rate of polyacrylamide hydrogel for endoscopic treatment of vesicoureteral reflux is comparable to published results of dextranomer hyaluronic acid. The long-term safety data and potential lower cost of polyacrylamide hydrogel provide further support for the use of this nonparticulate bulking agent to treat reflux.

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Measured adherence to antimuscarinics in children with overactive bladder is higher than in adults but significantly lower than the self-reported adherence. Good self-reported adherence must be questioned to avoid unnecessary dose escalation or change of medication. Strategies to increase medication adherence are required to improve treatment efficacy.

A 56-year-old man was referred to a reconstructive urologist for evaluation of a tender nodule in the penoscrotal area. Penile Doppler ultrasound showed a non-compressible mass with internal vascularity within the corpora spongiosum, and MRI identified an enhancing, solid mass arising from the ventral aspect of the urethra. Surgical resection warranted partial excision and reconstruction of the urethra, which was achieved by a dorsal onlay buccal mucosal graft urethroplasty through a perineal incision with penile invagination. The histopathology report concluded to an invasive, high-grade urothelial carcinoma, for which an aggressive oncological approach was considered. However, discussion with the pathology team led to the identification of a glomus tumour for which the patient did not need additional procedures. Urethral glomus tumours are extremely rare and should be included in the differential diagnosis of urethral masses. This case exemplifies the importance of teamwork in the management of uncommon cases.

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