[Efficacy of oxybutynin chloride in children with vesico-ureteral reflux and detrusor instability].
OBJECTIVE
The purpose of this study was to assess the urodynamic (UD), radiological (VCUG) and clinical outcome in patients with detrusor instability (DI) and vesico-ureteral reflux (VUR).


METHODS
UD and VCUG findings in 24 patients between 4 and 18 years of age (mean 7.6 years) with a simultaneous diagnosis of VUR and DI were reviewed. All presented with recurrent urinary tract infections (UTI). Twenty were female of whom 8 also had enuresis and daytime symptoms. Ten had bilateral VUR, making a total of 34 units. Mean follow-up was 40 months (range 18-97 months) and at least 2 UD studies were done. Treatment consisted of oxybutinin chloride (OC) and chemoprophylaxis.


RESULTS
Treatment lasted an average of 31 months with an average dose of 11 mg/day. There was a statistically significant improvement in UTI rate, enuresis score and UD parameters [CysCap, volume at 1st contraction, maximum contraction and compliance (comp)]. Thirteen patients achieved stable bladders and 9 had some UD improvement (3 with low compliance and 2 with less severe DI), leaving 2 with unchanged DI. Reflux disappeared in 20 units and was downgraded in 6. VUR improvement coincided with the cases of UD improvement. Persistence of DI was always associated with persistent VUR.


CONCLUSIONS
Oxybutinin treatment can be long, but UD and VUR improvement run parallel in most cases. The rare discrepant cases point towards a multifactorial ethology in this condition.
Batista Miranda
J E
JE
Unidad de Urodinamia, Fundación Puigvert, Barcelona.
Arañó Bertran
P
P
Caffaratti
J
J
Regalado Pareja
R
R
Garat Barredo
J M
JM
Errando Smet
C
C
Vicente Rodríguez
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D010276:Parasympatholytics / Q000627:therapeutic use*; D012720:Severity of Illness Index; D014463:Ultrasonography; D014551:Urinary Tract / Q000000981:diagnostic imaging / Q000187:drug effects; D014563:Urodynamics / Q000187:drug effects; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
D008333:Mandelic Acids; D010276:Parasympatholytics; C005419:oxybutynin
Eficacia del cloruro de oxibutinina en niños con inestabilidad del detrusor y reflujo vesicoureteral.