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Long-term intravesical oxybutynin chloride therapy in children with myelodysplasia
K A Painter1, T S Vates, T P Bukowski
1Department of Pediatric Urology, Children's Hospital of Michigan, Wayne State University, Detroit, USA.
Insights
Intravesical oxybutynin chloride offers a safe and effective treatment for children with neurogenic bladder dysfunction due to myelodysplasia when oral medications fail. This method improved bladder capacity and continence with no systemic side effects.
Area of Science:
- Pediatric Urology
- Neurology
- Pharmacology
Background:
- Neurogenic bladder dysfunction is a common complication in children with myelodysplasia.
- Oral anticholinergics are first-line treatments but often poorly tolerated.
- Alternative treatment strategies are needed for improved bladder management.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of long-term intravesical oxybutynin chloride.
- To assess its utility in pediatric patients with myelodysplasia unresponsive to oral anticholinergics.
Main Methods:
- Retrospective review of patients receiving intravesical oxybutynin chloride.
- Study included 30 children (12 female, 18 male) aged 1-17 years.
- Oxybutynin chloride (5 mg) instilled twice daily; outcomes assessed via cystograms and urodynamic studies over 2-26 months.
Main Results:
- Significant increases in mean total bladder capacity (209 to 282 ml) and safe capacity (157 to 234 ml) were observed (p < 0.01).
- Age-adjusted safe capacity improved from 76% to 115% (p < 0.01).
- 10% of incontinent patients achieved continence, and 65% reported reduced pad usage; no systemic side effects occurred.
Conclusions:
- Intravesical oxybutynin chloride is a viable and safe treatment option for pediatric neurogenic bladder.
- It offers a beneficial alternative for patients with myelodysplasia who cannot tolerate oral anticholinergic therapy.
Purpose:
We evaluated the clinical use of long-term intravesical oxybutynin chloride in the treatment of neurogenic bladder dysfunction in children with myelodysplasia who could not tolerate oral anticholinergics.
Materials And Methods:
We retrospectively reviewed the records of all patients recommended for intravesical oxybutynin chloride therapy. A total of 12 girls and 18 boys 1 to 17 years old was recruited for study. Oxybutynin chloride (5 mg.) was instilled 2 times daily and pretreatment cystograms were compared to followup urodynamic studies. Duration of therapy was 2 to 26 months (mean 13, median 12).
Results:
Mean total capacity plus or minus standard deviation increased from 209 +/- 103 to 282 +/- 148 ml. (p < 0.01), mean safe capacity increased from 157 +/- 105 to 234 +/- 147 ml. (p < 0.01) and mean age adjusted safe capacity increased from 76 +/- 36 to 115 +/- 62%. Of the 29 patients who were incontinent 3 (10%) achieved continence and 19 (65%) reported a decreased use of sanitary pads. None of the patients had systemic side effects related to intravesical treatment.
Conclusions:
We believe that intravesical oxybutynin chloride is a viable treatment option for patients with myelodysplasia in whom oral therapy fails.