Follow-up of long-time treatment with intravesical oxybutynin for neurogenic bladder in children.
OBJECTIVE
Anticholinergic treatment for the hyperreflexic neurogenic bladder in childhood is an established method, together with clean intermittent catheterization (CIC), to promote continence and protect the upper urinary tract from deterioration. Recently, the use of oxybutynin, a compound with anticholinergic, smooth muscle relaxant and local anesthetic effects, has become widely used with both oral and intravesical administration.


METHODS
In this study we report 39 children with myelodysplasia, neurogenic bladder disturbance with detrusor hyperreflexia and/or high bladder pressure treated with CIC to which intravesical oxybutynin 0.1 mg/kg twice daily was added and administered as a sterile pharmacy-produced solution. The follow-up period was 0.66-5 years (mean 2.25).


RESULTS
Continence was clearly promoted and urodynamic parameters improved whereas an increased occurrence of asymptomatic bacteriuria and lower urinary tract infections was noted. Compliance was good, adverse reactions rare, and in some cases vesicoureteral reflux (VUR) resolved. Also infants and very young children were treated without complications.


CONCLUSIONS
Intravesical oxybutynin is effective to diminish bladder pathophysiology and promote continence in this patient group and is also well tolerated. Attention should be paid to the occurrence of urinary tract infections and VUR may resolve.
Department of Pediatrics, Karolinska Hospital, Stockholm, Sweden. peram@child.ks.se
P
P
Amark
G
G
Bussman
S
S
Eksborg
D000283:Administration, Intravesical; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009436:Neural Tube Defects / Q000188:drug therapy; D010276:Parasympatholytics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001743:Urinary Bladder / Q000187:drug effects* / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy
D018680:Cholinergic Antagonists; D008333:Mandelic Acids; D010276:Parasympatholytics; C005419:oxybutynin