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Effects of oxybutynin on vesicoureteral reflux in children
Insights
Treating hyperreflexic bladder in children with oxybutynin significantly resolved or improved vesicoureteral reflux, especially in those with incontinence. This suggests bladder instability contributes to reflux, and lowering intravesical pressure aids resolution.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Gastroenterology
Background:
- Vesicoureteral reflux (VUR) in children is often associated with bladder dysfunction.
- Hyperreflexic bladder, with or without vesicoperineal dyssynergia, is a common urodynamic finding in neurologically normal children with VUR.
- The role of bladder instability in the pathogenesis and persistence of VUR requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of oxybutynin therapy in children with VUR and hyperreflexic bladder.
- To determine the impact of treating bladder instability on VUR resolution.
- To assess changes in bladder capacity and their correlation with VUR outcomes.
Main Methods:
- Retrospective review of 40 neurologically normal children with VUR (53 ureters) treated between 1980 and 1984.
- Urodynamic evaluation to assess bladder function (hyperreflexic bladder, vesicoperineal dyssynergia).
- Treatment with prophylactic antibiotics and oxybutynin for bladder hyperreflexia (3-18 months).
Main Results:
- VUR resolved or downgraded to Grade I in 62.3% of ureters.
- In children with urinary incontinence, VUR resolution was observed in 78.6%.
- Oxybutynin increased mean bladder capacity by 97 cc (54.2%), an effect sustained post-treatment.
Conclusions:
- Bladder instability is a significant factor in the development and perpetuation of VUR.
- Therapeutic strategies aimed at reducing intravesical pressure, such as oxybutynin, can promote VUR resolution or downgrading.
- Effective management of hyperreflexic bladder may be crucial for improving VUR outcomes in pediatric patients.
Abstract:
We reviewed retrospectively 40 children seen from 1980 to 1984 with vesicoureteral reflux in 53 ureters. All patients had a hyperreflexic bladder on urodynamic evaluation with or without vesicoperineal dyssynergia but they were otherwise neurologically normal. All except 1 child received prophylactic antibiotics. Of the children 37 received oxybutynin therapy for bladder hyperreflexia for 3 to 18 months. Reflux disappeared or became grade I in 62.3 per cent of the ureters. Of the children manifesting urinary incontinence at the time of urodynamic study reflux disappeared or became grade I in 78.6 per cent. Reflux resolved or became grade I in 20 per cent of the children with no urinary incontinence. Of those patients with recurrent reflux at the onset of urinary incontinence and bladder instability reflux resolved or became grade I in 80 per cent. Oxybutynin therapy for hyperreflexic bladder resulted in an average increase in bladder capacity of 97 cc (54.2 per cent), which was maintained after cessation of treatment. These data suggest that bladder instability can be an important factor in causing and perpetuating reflux. Therapy aimed at decreasing intravesical pressure will enhance resolution or downgrading of reflux.