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Treatment with modified intravesical oxybutynin chloride for neurogenic bladder in children
Atsushi Hayashi1, Motoaki Saito, Shin-ichi Okada
1Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Yonago, Japan.
Insights
Modified intravesical oxybutynin effectively treats neurogenic bladder in children, improving bladder capacity, compliance, and incontinence with minimal side effects. This therapy offers a safe alternative for pediatric patients unresponsive to oral medications.
Area of Science:
- Pediatric Urology
- Pharmacology
- Nephrology
Background:
- Neurogenic bladder in children often leads to detrusor overactivity and low bladder compliance.
- Oral anticholinergic medications can cause intolerable side effects in pediatric patients.
- Modified intravesical oxybutynin has shown promise for managing detrusor overactivity.
Purpose of the Study:
- To evaluate the efficacy and safety of modified intravesical oxybutynin in children with neurogenic bladder.
- To assess improvements in bladder capacity, compliance, and incontinence.
- To monitor for anticholinergic side effects and urinary tract infections.
Main Methods:
- Four children with neurogenic bladder received modified intravesical oxybutynin (1.25mg/5 mL, twice daily).
- Cystometrograms were performed before treatment, at 1 week, and at 1 year.
- Patients were monitored for side effects, urinary tract infections, and incontinence levels.
Main Results:
- Significant improvements in cystometric bladder capacity and compliance were observed within 1 week.
- Detrusor overactivity resolved in most patients by 1 year.
- Marked reduction in incontinence was achieved with no systemic anticholinergic side effects.
- One patient discontinued treatment due to upper urinary tract infections.
Conclusions:
- Modified intravesical oxybutynin is an effective and safe treatment for pediatric neurogenic bladder.
- This intravesical approach offers a viable alternative for children who cannot tolerate oral medications.
- Further research may explore long-term outcomes and optimal use in specific pediatric uropathy cases.
Objective:
We have previously reported that intravesical oxybutynin chloride with hydroxypropylcellulose (modified intravesical oxybutynin) is an effective therapeutic agent for patients with detrusor overactivity. In this study, we report on the efficacy, safety and side effects of modified intravesical oxybutynin administration in children with neurogenic bladder.
Patients:
Modified intravesical oxybutynin (1.25mg/5 mL, twice a day) was administered to four children (three males and one female) with neurogenic bladder (detrusor overactivity and/or low compliance bladder), who were previously unresponsive to or experienced intolerable side effects from oral medications. A cystometrogram was obtained before, 1 week after, and 1 year after the first intravesical instillation of modified oxybutynin. We also carefully observed anticholinergic side effects, occurrence of urinary tract infection and degree of incontinence during this treatment.
Results:
After 1 week, both cystometric bladder capacity and compliance were improved in all patients, and detrusor overactivity was undetectable in three of four patients. At 1 year, there was further improvement in bladder compliance in three patients, and detrusor overactivity was not observed in two patients. Significant improvement in the degree of incontinence was achieved. No systemic anticholinergic side effects were observed in any of the patients. One patient with vesicoureteral reflux discontinued the therapy after 2 months due to upper urinary tract infections.
Conclusion:
Modified intravesical oxybutynin is an effective and relatively safe therapeutic option for children with neurogenic bladders.
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