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Expanded followup of intravesical oxybutynin chloride use in children with neurogenic bladder
R Kaplinsky1, S Greenfield, J Wan
1Department of Urology, Children's Hospital of Buffalo, State University of New York, New York, USA.
Insights
Intravesical oxybutynin chloride offers a durable solution for children with neurogenic bladders, improving continence and bladder function. This treatment spares many from invasive bladder augmentation surgery.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Pharmacological Interventions
Background:
- Neurogenic bladder in children often leads to urinary incontinence and elevated bladder pressures.
- Oral anticholinergic medications may be poorly tolerated or ineffective.
- Alternative treatment strategies are crucial for managing complex pediatric bladder conditions.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of intravesical oxybutynin chloride in children with neurogenic bladders.
- To assess the impact of intravesical oxybutynin on urodynamic parameters and continence.
- To determine if this treatment can prevent the need for bladder augmentation.
Main Methods:
- A retrospective review of 28 children with neurogenic bladders refractory to other treatments.
- Intravesical administration of 5 mg oxybutynin chloride in 10 cc sterile saline twice daily during catheterization.
- Assessment of continence, urodynamic parameters, and adverse events.
Main Results:
- 25% of patients experienced intolerable anticholinergic side effects.
- Of the remaining 21 patients, 57% achieved complete day and night continence, and 24% achieved daytime continence.
- Significant urodynamic improvements included a mean 237% increase in bladder capacity and a 31% decrease in maximum filling pressures.
Conclusions:
- Intravesical oxybutynin chloride provides significant urodynamic and continence improvements in children with neurogenic bladders.
- The treatment demonstrates durable efficacy over a mean follow-up of 35 months.
- Intravesical oxybutynin is a viable alternative to bladder augmentation for many pediatric patients.
Purpose:
We evaluated the long-term results of intravesical oxybutynin chloride use in children with neurogenic bladders who could not tolerate or whose conditions were refractory to oral therapy.
Materials And Methods:
We reviewed our experience with 28 children (myelomeningocele in 27 and imperforate anus in 1) who presented with urinary incontinence and/or elevated bladder pressures refractory to intermittent catheterization and oral anticholinergic medication. Intravesical oxybutynin was administered to each child by instillation of 5 mg. crushed oxybutynin chloride in 10 cc sterile saline 2 times daily during catheterization.
Results:
Seven patients (25%) could not tolerate intravesical oxybutynin secondary to anticholinergic side effects. The remaining 21 children have been followed on intravesical oxybutynin for a mean of 35 months (range 3 to 67). Of these 21 children 12 (57%) became completely dry day and night, 5 (24%) achieved daytime continence between catheterizations and 4 (19%) remained clinically unchanged with 2 in diapers. On urodynamics these 21 patients had increased bladder capacity of up to 1,150% (mean 237%, p < 0.0001) and decreased mean maximum filling pressures of -31% (p = 0.002).
Conclusions:
Although a number of patients continued to have anticholinergic side effects, a majority had significant improvement in urodynamic parameters and continence. The response appears to be durable, and it spares many of these children from undergoing bladder augmentation.