Role of gabapentin and anticholinergics in management of neurogenic bladder after repair of spina bifida - a randomized controlled study.
BACKGROUND
Anticholinergics are well established in the management of neurogenic bladders. However, some patients do have sub-optimal response or severe side effects. This study is designed to assess and compare efficacy of gabapentin with oxybutynin in neurogenic bladders after surgery for spina bifida.


METHODS
Patients were randomized into three groups after urodynamic studies and started on oxybutynin, gabapentin, and combination of both, respectively. Thorough clinical and urodynamic reassessment was done at 6months and one year after starting treatment.


RESULTS
Forty-four patients (3-19years) were studied. Improvement was noted in symptoms as well as urodynamic parameters in all groups. Maximal improvement of symptom score was with combination of drugs at 1year. In urodynamic studies, compliance, pressures, and capacity showed improvement, which was significant between the groups at both six months and 1year for bladder pressures and volume. Improvement in compliance though marked was not statistically significant. Best response was seen in group receiving both drugs. Gabapentin was better tolerated than oxybutynin.


CONCLUSIONS
Gabapentin is a good alternative to oxybutynin for management of neurogenic bladder, both as monotherapy and as an add-on therapy. It has potential application in patients with inadequate response to anticholinergics.


METHODS
prospective competitive treatment study - level II.
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Vedarth
V
Dash
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Electronic address: monikabawa@hotmail.com.
Monika
M
Bawa
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J K
JK
Mahajan
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Ravi P
RP
Kanojia
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Ram
R
Samujh
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
K L N
KL
Rao
D000293:Adolescent; D000588:Amines / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D011446:Prospective Studies; D016135:Spinal Dysraphism / Q000150:complications / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D064804:Urological Agents / Q000627:therapeutic use*; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
D000588:Amines; D018680:Cholinergic Antagonists; D003509:Cyclohexanecarboxylic Acids; D008333:Mandelic Acids; D064804:Urological Agents; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; C005419:oxybutynin
Anticholinergics; Clean intermittent catheterization; Gabapentin; Neurogenic bladder; Spina bifida; Urodynamics