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Intravesical oxybutynin for children with poorly compliant neurogenic bladder: a systematic review
Luis Antonio Guerra1, David Moher, Margaret Sampson
1Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. lguerra@uottawa.ca
Insights
Intravesical oxybutynin may improve bladder capacity and reduce pressure in children with neurogenic bladder, but evidence is limited. Further research is needed to confirm its effectiveness and safety.
Area of Science:
- Pediatric Urology
- Pharmacology
- Nephrology
Background:
- Children with neurogenic bladder and poor bladder compliance often require catheterization and oral anticholinergic medication.
- Oral anticholinergics can lead to non-response or severe side effects in pediatric patients.
- Intravesical administration of medications offers an alternative route for targeted delivery.
Purpose of the Study:
- To evaluate the effectiveness and tolerability of intravesical oxybutynin in children with poorly compliant neurogenic bladder.
- To assess the impact of intravesical oxybutynin on bladder capacity and pressure.
- To determine the rate of treatment discontinuation and side effects associated with intravesical oxybutynin.
Main Methods:
- A comprehensive literature search was conducted across multiple databases, including MEDLINE, EMBASE, CINAHL, SciELO, ProQuest, LILACS, and the Cochrane Library.
- Two independent reviewers assessed study quality and extracted relevant data from eligible studies.
- Included studies focused on children with neurogenic bladder treated with intravesical oxybutynin.
Main Results:
- Eight studies (2 prospective, 6 retrospective) involving 297 children were analyzed.
- Treatment discontinuation occurred in 22% of patients, with 9% due to systemic side effects.
- Pooled analysis showed a mean decrease in bladder pressure at maximum capacity of -16.4 cm H2O, and incontinence improved in most patients (61%-83% "dry and improved" rates).
Conclusions:
- Intravesical oxybutynin therapy demonstrated potential in increasing bladder capacity and decreasing bladder pressure in pediatric neurogenic bladder.
- However, the current evidence is of low quality, primarily from retrospective studies with potential biases.
- While side effect incidence may be lower than oral routes, they are still possible, and high-quality research, such as randomized controlled trials, is needed.
Purpose:
Children with neurogenic bladder and poor bladder compliance are usually treated with bladder catheterization and oral anticholinergic medication. They may become nonresponders to the drug or present with severe side effects. We evaluated the effectiveness and tolerability of intravesical oxybutynin in children with poorly compliant neurogenic bladder.
Materials And Methods:
We conducted a search of MEDLINE, EMBASE, CINAHL, SciELO, dissertations/theses in ProQuest, LILACS, the Cochrane Library, protocol registries and the gray literature. Two reviewers independently assessed study quality and extracted data.
Results:
Eight studies (2 prospective, 6 retrospective) assessed the effectiveness and side effects of intravesical oxybutynin in children with neurogenic bladder. A total of 297 children started treatment, of whom 22% (66 patients) discontinued therapy, with 9% (28) quitting due to systemic side effects. Mean change in bladder compliance (primary outcome) was reported in only 2 studies (+7.4 and +7.5 ml/cm H(2)O). The pooled mean change in pressure at maximum bladder capacity was -16.4 cm H(2)O (95% CI -22.8 to -10.0). Incontinence improved significantly in most studies, with "dry and improved" rates ranging from 61% to 83%. The funnel plot of pressure at maximum bladder capacity suggested no publication bias.
Conclusions:
Adjunctive intravesical oxybutynin therapy increased mean maximum bladder capacity and decreased bladder pressure in children with neurogenic bladder. However, identified studies offered a low level of evidence, with most being poorly reported retrospective case series with potential biases. Although the incidence of side effects was lower with the intravesical route, side effects are still possible and should be discussed with patients and families. The evidence available is insufficient to recommend this therapy. Research of more sound study design such as a randomized controlled trial should be conducted to assess the efficacy and side effects of intravesical oxybutynin in children.
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