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Intravesical oxybutinin chloride in children with intermittent catheterization: sonographic findings
J M Zerin1, M A DiPietro, M L Ritchey
1Department of Radiology, Riley Hospital for Children, Indiana University Medical Center, Indianapolis 46202-2920.
Insights
Ultrasound of the bladder in children with neurogenic bladder dysfunction may show unusual findings after intravesical oxybutynin chloride administration. These sonographic changes can mimic other conditions, necessitating a review of medication history.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Pharmacology
Background:
- Myelomeningocele often leads to neurogenic bladder dysfunction.
- Intermittent self-catheterization and intravesical medications are common management strategies.
- Oxybutynin chloride is used to manage bladder spasticity.
Observation:
- Four children with myelomeningocele and neurogenic bladder dysfunction underwent routine urinary tract sonography.
- Oxybutynin chloride was instilled intravesically 30-120 minutes prior to sonography.
- Distinct sonographic appearances of the bladder urine were observed.
Findings:
- Echogenic, non-shadowing particles were seen suspended in the urine, creating "snowstorm" or settling clump appearances.
- Other cases showed diffusely hazy urine with a "fine mist" appearance.
- These sonographic findings are attributed to the crushed oxybutynin chloride medication.
Implications:
- The sonographic appearance of intravesical medication can be dramatic and mimic pathological conditions like pus or blood.
- Clinicians should consider recent intravesical medication instillation when interpreting bladder sonography in these patients.
- A thorough clinical history, including recent medication administration, is crucial to avoid misdiagnosis.
Abstract:
The sonographic findings in the bladder are presented in four children with myelomeningocele and neurogenic dysfunction of the bladder, who were treated with intermittent self-catheterization and intravesical oxybutinin chloride. All were referred for routine sonography of the urinary tract. Each had infused a crushed tablet of oxybutinin chloride intravesically 30-120 min before the examination. In two children, brightly echogenic, non-shadowing particles were suspended in the bladder urine. In one of these, the particles swirled giving the impression of a "snowstorm"; in the other, most of the particles gradually settled forming an irregular clump on the bladder base. In the remaining two children, the urine appeared diffusely hazy with innumerable tiny particles giving the impression of a fine mist filling the bladder. The sonographic appearance of the urine in the bladder after intravesical instillation of crushed tablets can be dramatic and can simulate pus, blood, fungus, or other debris in the bladder lumen. In the absence of clinical symptoms or hematuria, a history of recent infusion of medication into the bladder should be sought.