Efficacy of trospium chloride in the treatment of overactive bladder: a systematic review and meta-analysis

Kuzmin I.V., Slesarevskaya M.N., Al-Shukri S.Kh.

Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia

Introduction. Overactive bladder (OAB) is one of the most common causes of voiding dysfunction. The prevalence of OAB in adults ranges from 15% to 25%. Drug therapy is the mainstay of OAB treatment; however, many aspects of it remain insufficiently studied.
Aim. To evaluate the efficacy of the anticholinergic drug trospium chloride in the treatment of overactive bladder in adults and children.
Materials and methods. The study was carried out in accordance with the PRISMA criteria. A search was performed in eLibrary, PubMed, EMBASE, Web of Science, and the Cochrane Library for the period 1991-2025. Randomized and non-randomized controlled studies, as well as prospective observational studies with quantitative data (M±SD or OR/proportions), were included in the analysis. In adult studies, a control group was mandatory; in pediatric studies, before-after studies were allowed. A total of 28 studies were included in the analysis, including 20 in adults and 8 in children. The total number of patients receiving trospium chloride was 2807, including 2497 adults and 310 children.
Results. The obtained data indicate high efficacy of trospium chloride in different age groups. In adults, treatment with trospium chloride resulted in a clinically significant reduction in urinary frequency (SMD -0.67; 95% CI -0.78 to -0.56), a 71% reduction in the risk of urgency urinary incontinence (OR 0.29; 95% CI 0.22 to 0.38), and an increase in mean voided volume by 52.8 mL (95% CI 42.1 to 63.5). A trend toward a dose-dependent effect of trospium chloride was identified: a dose of 60 mg/day was more effective than 20-30 mg/day (p=0.07; R2=0.35). In children, trospium chloride was associated with complete resolution of urinary incontinence in 46% of patients, an increase in bladder capacity by a mean of 45.8 mL, and a more pronounced reduction in urinary frequency than in adults (SMD -1.21; in absolute values, by 6.9 episodes per day: from 16.2 to 9.3).
Conclusion. The results of this meta-analysis indicate high efficacy of trospium chloride in the treatment of OAB. TC may be considered a first-line anticholinergic therapy in adults with OAB. High efficacy was also observed in children; however, additional randomized placebo-controlled studies are required.

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About the Authors

Corresponding author: I.V. Kuzmin - Ph.D., MD, Professor, Department of Urology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, St. Petersburg, Russia; e-mail: kuzminigor@mail.ru

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