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Effect of Early Oxybutynin Treatment on Posterior Urethral Valve Outcomes in Infants: A Randomized Controlled Trial
Ahmed Abdelhalim1, Ahmed S El-Hefnawy1, Mohamed E Dawaba1
1Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Insights
Oxybutynin improved upper urinary tract outcomes in infants after posterior urethral valve ablation. The medication aided hydronephrosis improvement and vesicoureteral reflux resolution, though monitoring is advised.
Area of Science:
- Pediatric Urology
- Pharmacology
- Nephrology
Background:
- Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
- Endoscopic valve ablation is the primary treatment, but complications like upper tract deterioration can occur.
- Understanding adjunctive therapies to improve outcomes is crucial.
Purpose of the Study:
- To evaluate the efficacy of oxybutynin in improving bladder and upper urinary tract outcomes in infants post-PUV ablation.
- To compare renal function, hydronephrosis, vesicoureteral reflux, and infection rates between infants treated with oxybutynin and those under observation.
Main Methods:
- A randomized controlled trial involving infants younger than 12 months undergoing primary endoscopic PUV ablation.
- Patients received either oxybutynin (0.2 mg/kg TID) until toilet training or active observation.
- Study endpoints included serum creatinine, eGFR, hydronephrosis improvement, VUR resolution, UTI, and toilet training.
Main Results:
- No significant differences in serum creatinine or eGFR between oxybutynin and observation groups.
- Oxybutynin group showed significantly greater improvement in hydronephrosis (61.9% vs 34.8%, p=0.011) and VUR resolution (62.5% vs 25%, p=0.023).
- No significant differences in febrile UTI rates or toilet training outcomes.
Conclusions:
- Oxybutynin demonstrates a beneficial effect on hydronephrosis improvement and vesicoureteral reflux resolution in infants following PUV ablation.
- Periodic monitoring is recommended for infants receiving oxybutynin post-ablation.
- Oxybutynin may be a valuable adjunct therapy in managing infants with PUV.
Purpose:
We studied the effect of oxybutynin on bladder and upper urinary tract outcomes in infants following posterior urethral valve ablation.
Materials And Methods:
Patients younger than 12 months old who had undergone primary endoscopic valve ablation for posterior urethral valves were screened for eligibility. Patients who had undergone urinary diversion or had other conditions that could affect lower urinary tract function were excluded. Study patients were randomized to either oxybutynin (0.2 mg/kg 3 times daily) until toilet training or active observation. The study end points were serum creatinine, estimated glomerular filtration rate, hydronephrosis improvement, vesicoureteral reflux resolution, febrile urinary tract infection and toilet training.
Results:
A total of 49 infants (24 receiving oxybutynin and 25 undergoing observation) were enrolled between December 2013 and September 2015 and completed at least 1 year of followup. Oxybutynin was discontinued before toilet training in 5 patients due to facial flushing in 2, bladder and upper tract dilatation in 2, and cognitive changes in 1. After a median followup of 44.2 months (range 12 to 57.6) median serum creatinine and estimated glomerular filtration rate were not significantly different between the groups (p=0.823 and p=0.722, respectively). Renal units in the oxybutynin group had a greater likelihood of hydronephrosis improvement (61.9% vs 34.8%, p=0.011) and resolution of vesicoureteral reflux (62.5% vs 25%, p=0.023). Febrile urinary tract infection (29.2% vs 40%, p=0.404), completion of toilet training (70.8% vs 76%, p=0.748) and age at toilet training (p=0.247) did not differ significantly between the oxybutynin and observation groups.
Conclusions:
Oxybutynin enhances hydronephrosis improvement and vesicoureteral reflux resolution following primary endoscopic valve ablation in infants but periodic monitoring is warranted.
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