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Intravesical therapy for the treatment of neurogenic bladder in children
A J Holland1, P A King, P J Chauvel
1Department of Paediatric Surgery, Princess Margaret Hospital for Children, Subiaco, Australia.
Insights
Intravesical oxybutynin and ephedrine offer a safe alternative for children with neurogenic bladder incontinence unresponsive to oral medications. This treatment shows promise in managing complex cases, potentially avoiding surgery.
Area of Science:
- Urology
- Pediatric Nephrology
- Pharmacology
Background:
- Oral pharmacotherapy is a common adjunct to clean intermittent catheterization (CIC) for neurogenic bladder continence.
- Oral medications can cause unacceptable side effects.
- Intravesical preparations of oxybutynin hydrochloride and ephedrine are explored as alternatives.
Purpose of the Study:
- To report the authors' experience with sterile intravesical oxybutynin hydrochloride and ephedrine in children.
- To evaluate the efficacy and safety of intravesical agents for managing refractory neurogenic bladder incontinence in pediatric patients.
Main Methods:
- Study included pediatric patients with neurogenic bladder incontinence unresponsive to oral therapy or with severe side effects.
- Patients underwent clinical, radiological, and urodynamic assessments before intravesical oxybutynin hydrochloride treatment.
- Intravesical ephedrine was added for patients remaining incontinent with poor internal sphincter tone.
Main Results:
- Two of seven patients achieved continence with intravesical therapy.
- One patient showed improved upper tract dilatation, and another became continent with combined oxybutynin and ephedrine.
- Three patients did not respond to treatment; side effects were minimal.
Conclusions:
- Intravesical agents are valuable for managing pediatric neurogenic bladder in cases of severe oral pharmacotherapy side effects, potentially preventing surgery.
- Sterile intravesical therapy is a safe treatment modality for children.
- Further research into intravesical therapy for pediatric neurogenic bladder is warranted.
Background:
Oral pharmacotherapy has been commonly used as an adjunct to clean intermittent catheterization (CIC) in the treatment of neurogenic bladder in order to achieve continence, but may be associated with unacceptable side effects. The authors' experience with sterile intravesical preparations of oxybutynin hydrochloride and ephedrine in children is reported here.
Methods:
Patients requiring CIC for neurogenic bladder but with incontinence that was unresponsive to standard oral therapy or that was associated with severe systemic side effects were studied over a 1-year period. Clinical, radiological and urodynamic assessments were made prior to commencing treatment with intravesical oxybutynin hydrochloride. Patients who remained incontinent with poor internal sphincter muscle tone had intravesical ephedrine added.
Results:
Seven patients were involved in the study over a 1-year period. Two patients became continent and one patient had an improvement in upper tract dilatation. One patient had a limited improvement with oxybutynin alone but became continent with the addition of ephedrine. Three patients had no response to treatment. There were few side effects.
Conclusion:
Intravesical agents have a role in the management of paediatric neurogenic bladder for those children with significant adverse sequelae from oral pharmacotherapy who would otherwise require surgical intervention. Intravesical therapy is a safe technique in children with sterile preparations. Further investigation of this modality should be pursued.