Control of detrusor hyperreflexia by the intravesical instillation of oxybutynine hydrochloride

This report deals with the control of detrusor hyperreflexia by the intravesical instillation of oxybutynin hydrochloride (OH) in 10 male and 3 female patients with complete suprasacral spinal cord lesions having clean intermittent catheterisation (CIC) because of unbalanced voiding. The indication for intravesical OH application was persisting urinary incontinence despite CIC in 11 patients and in 2 patients detrusor hypercontractility. One 5 mg tablet of OH was dissolved in distilled water and the solution was instilled into the bladder through the catheter, which has been used for urodynamics and which was then removed. Six hours later cystometry was repeated and the clinical effects were studied especially with regard to continence/incontinence and side-effects. The differences in the cystometric bladder capacity and maximum detrusor pressure before and after instillation of OH are statistically highly significant. Clinically, from those 10 patients who were incontinent between CIC before, 9 remained dry during the 6-hour period. None of the patients reported any side-effect after intravesical application of OH. However, with subsequent oral medication 8 out of 12 patients complained of typical anticholinergic side-effects. These results indicate that treatment with topical OH is an effective alternative to treating detrusor hyperreflexia, especially in patients already on CIC because of unbalanced voiding, but with persisting urinary incontinence due to detrusor hyperreflexia. OH is well absorbed from the bladder, however absorption seems to be protracted compared to oral intake.