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Intravesical application of a stable oxybutynin solution improves therapeutic compliance and acceptance in children
G Buyse1, C Verpoorten, R Vereecken
1Department of Paediatrics, University Hospitals Gasthuisberg, Leuven, Belgium.
Insights
A new stable oxybutynin solution improved intravesical therapy compliance for children with neurogenic bladder. This simplified treatment eliminated complex preparation, proving safe and effective for detrusor hyperactivity.
Area of Science:
- Pediatric Urology
- Pharmacology
- Nephrology
Background:
- Neurogenic bladder dysfunction in children often requires treatment with oxybutynin.
- Traditional oral oxybutynin therapy can lead to significant side effects and poor patient compliance.
- The preparation of intravesical oxybutynin historically involved a complicated crushing procedure, hindering acceptance.
Purpose of the Study:
- To develop a stable intravesical oxybutynin solution to improve patient compliance and acceptance.
- To eliminate the need for a complicated crushing procedure in preparing intravesical oxybutynin therapy.
Main Methods:
- A prospective evaluation of 15 children (mean age 6.1 years) with neurogenic bladder dysfunction.
- Children received intravesically 0.2 mg/kg (max 5 mg) of a stable oxybutynin solution (5 mg/5 ml, pH 5.85) twice daily.
- The study period was from January 1995 to January 1997.
Main Results:
- The oxybutynin solution demonstrated stability for up to 24 months.
- Excellent therapeutic compliance was observed in 13 out of 15 children.
- Significant improvements were noted: decreased detrusor hyperactivity, absent/minimal systemic side effects, increased mean cystometric bladder capacity (p <0.01), and decreased end-filling bladder pressure (p <0.01).
Conclusions:
- Intravesical instillation of the specially prepared oxybutynin solution is safe and reliable for children.
- This simplified therapy effectively manages persistent detrusor hyperactivity and side effects from oral oxybutynin.
- Eliminating complex preparation enhances long-term usability and patient acceptance of intravesical oxybutynin.
Purpose:
To improve patient compliance with and acceptance of intravesical oxybutynin therapy for neurogenic bladder dysfunction we developed a stable oxybutynin solution that eliminates the complicated crushing procedure.
Materials And Methods:
From January 1995 to January 1997 we prospectively evaluated 15 children with a mean age of 6.1 years with persistent detrusor hyperactivity or significant side effects on oral oxybutynin therapy who received intravesically 0.2 mg./kg. (maximum 5 mg.) of a stable oxybutynin solution (5 mg./5 ml., pH 5.85) twice daily.
Results:
The oxybutynin solution remained stable up to 24 months. In 13 of the 15 children therapeutic compliance was excellent. Detrusor hyperactivity decreased and systemic side effects were absent or minimal. After 4 and 24 months mean cystometric bladder capacity plus or minus standard error of mean increased from 114+/-15.2 to 161+/-26.6 and 214+/-21.7 ml. (p <0.01), mean ratio of cystometric-to-expected bladder capacity increased from 0.88+/-0.12 to 1.18+/-0.14 and 1.24+/-0.16 (p <0.01), and end filling bladder pressure decreased from 57.0+/-7.1 to 25.6+/-4.4 and 30.8+/-4.4 cm. water (p <0.01), respectively.
Conclusions:
Intravesical instillation of a specially prepared oxybutynin solution is safe and reliable in children with persistent detrusor hyperactivity or side effects on oral oxybutynin therapy. Eliminating the complex crushing preparation of the solution by the child or parent has made this therapy easy to use and acceptable in the long term.