Topical oxybutynin chloride for relaxation of dysfunctional bladders

Eleven patients with persistent urge incontinence and frequent side effects on oral anticholinergic agents were treated with oxybutynin chloride administered intravesically. Five mg. tablets were dissolved in saline, and the solution was instilled twice daily and retained for 30 minutes. One patient was unable to retain the medication because of severe detrusor hyperreflexia and was eliminated from the study. The remaining 10 patients all reported subjective improvement following treatment and all became totally continent. No side effects were observed. In these 10 patients mean bladder capacity increased from 224 to 360 ml. (p less than 0.01) and mean maximum filling pressure decreased from 33 to 24 cm. water (p equals 0.17). Two additional patients with continent ileocecal urinary diversions were treated with topical oxybutynin chloride instilled directly into the intestinal reservoir. Both patients reported improved comfort with filling and 1 demonstrated a decrease in uninhibited contractions. These encouraging results suggest that treatment with topical oxybutynin chloride is an effective alternative in patients with voiding dysfunction who either are unresponsive to or have intolerable side effects on oral medications.