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The results in this report are relevant only in those countries in which the once-daily form of oxybutynin is unavailable. The once-daily form, because of less first-pass liver metabolism, has fewer side-effects than the immediate-release form, and represents the ‘reference standard’ of oral oxybutynin therapy [1]. Noteworthy in this article are: (i) the lack of any significant difference in efficacy variables between the active drugs; (ii) the presence of a difference in side-effect profile (dry mouth particularly); and (iii) the relatively small difference in efficacy variables between both active drugs and placebo, yet accounting for significant differences in quality of life. There is now a published direct comparison of the once-daily oral forms of tolterodine and oxybutynin [2]. Although both relieve symptoms and have fewer side-effects than the once-daily counterparts, it is clear that newer forms of pharmacological therapy, directed either at inhibiting cholinergic activation of the detrusor with greater efficacy and/or tolerability, or at inhibiting different motor or sensory mechanisms, would be welcome for the treatment of OAB.

A.J. WEIN, MD, Professor & Chair, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA

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    Diokno AC, Appell RA, Sand PK et al. for the OPERA Study Group. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA Trial. Mayo Clin Proc 2003; 78: 68795