Purpose <p>The treatment of overactive bladder (OAB), which is commonly seen in children, is primarily based on standard urotherapy and anticholinergics. This study aimed to evaluate the efficacy of anticholinergics in OAB and clinical factors affecting treatment outcomes.</p> Methods <p>The data of children with OAB included demographic and clinical data, Dysfunctional Voiding Symptom Score, and voiding diaries. Three anticholinergic agents—oxybutynin, propiverine, and tolterodine—were assessed. The treatment response was categorized as complete, partial, or non-response.</p> Results <p>Of 164 patients, 20.1% responded to urotherapy, while the remaining (mean age 7.7 ± 3.3 years; 54.2% male) required anticholinergic treatment. The first-line anticholinergic was oxybutynin in 86 (65.6%) patients, propiverine in 30 (22.9%), and tolterodine in 15 (11.5%). Treatment outcomes were similar (<i>p</i> = 0.35), but propiverine and tolterodine had fewer side effects than oxybutynin (<i>p</i> = 0.027). The overall success rate was 95.4% (<i>n</i> = 125), with 85.5% (<i>n</i> = 112) achieving complete and 9.9% (<i>n</i> = 13) partial responses. Higher daily voids were correlated with raised odds of a partial/no response to initial anticholinergic (OR: 1.15, 95% CI: 1.01–1.32, <i>p</i> = 0.039). Tolterodine correlated with decreased odds of partial/no response (OR: 0.15, 95% CI: 0.03–0.77, <i>p</i> = 0.023).</p> <p><i>Conclusion</i>: Anticholinergics show similar efficacy in treating OAB, though oxybutynin is associated with more side effects. Tolterodine reduced the odds of non-complete response, while a higher daily voids increased it.</p> <p><i>Trial registration</i>: NCT07046156, date of registration: 30/06.2025 retrospectively registered.</p> <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> <p><b>What is Known:</b></p> <p>•&#xa0;<i>Treatment of overactive bladder in children mainly relies on standard urotherapy and anticholinergic agents.</i></p> </entry> </row> <row> <entry nameend="c2" namest="c1"> <p><b>What is New:</b></p> <p>•&#xa0;<i>Oxybutynin caused more adverse effects than tolterodine or propiverine despite similar treatment outcomes.</i></p> <p>•&#xa0;<i>Tolterodine increased the likelihood of complete response, while a higher number of daily voids reduced it.</i></p> </entry> </row> </tbody> </tgroup> </Table>