Early administration of oxybutynin improves bladder function and clinical outcomes in newborns with posterior urethral valves.
OBJECTIVE
Abnormal bladder function following posterior urethral valve ablation can lead to deleterious effects on renal function and urinary continence. We performed a pilot study to determine if bladder dysfunction could be ameliorated by the early administration of oxybutynin.


METHODS
We enrolled infants who underwent primary posterior urethral valve ablation by the age of 12 months. On initial urodynamics patients demonstrating high voiding pressures (greater than 60 cm H(2)O) and/or small bladder capacity (less than 70% expected) were started on oxybutynin. Urodynamics and ultrasound were performed every 6 months until completion of toilet training, at which time oxybutynin was discontinued.


RESULTS
Oxybutynin was started in 18 patients at a mean age of 3.4 months and was continued for a mean of 2.2 years. Urodynamics revealed that initial high voiding pressures improved from a mean of 148.5 to 49.9 cm H(2)O in 15 of 17 patients. All 8 patients with initially poor bladder compliance demonstrated improvement on oxybutynin. All 7 patients with initially low bladder capacity (mean 47.7% expected bladder capacity) demonstrated improvement while on oxybutynin (mean 216% expected bladder capacity).


CONCLUSIONS
This pilot study demonstrates that early use of anticholinergic therapy in infants with high voiding pressures and/or small bladder capacity after primary posterior urethral valve ablation has beneficial effects on bladder function.
Division of Urology, Children's Memorial Hospital and Department of Urology, The Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA. jtcasey@fsm.northwestern.edu
Jessica T
JT
Casey
Jennifer A
JA
Hagerty
Max
M
Maizels
Antonio H
AH
Chaviano
Elizabeth
E
Yerkes
Bruce W
BW
Lindgren
William E
WE
Kaplan
Theresa
T
Meyer
Earl Y
EY
Cheng
D061345:Early Medical Intervention; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008333:Mandelic Acids / Q000627:therapeutic use*; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D001743:Urinary Bladder / Q000187:drug effects* / Q000502:physiology*
D008333:Mandelic Acids; D018727:Muscarinic Antagonists; C005419:oxybutynin