Abstract
Neuropathic bladder dysfunction caused by spinal cord disease may lead to irreversible renal damage and urinary incontinence. The majority of affected children can be successfully managed with standard medical treatment such as oral anti-cholinergic medication (typically oxybutynin or tolterodine) with or without Clean Intermittent Catheterization (CIC). The efficacy of this treatment, however, may be hampered as some of these patients experience severe Adverse Events (AEs) or insufficient suppression of detrusor over activity following oral anti-muscarinic pharmacotherapy. Intravesical oxybutynin chloride is an effective therapy for neurogenic bladder dysfunction; this review considers the indications, administration, safety, and efficacy of intravesical oxybutynin chloride instillation. In addition, some cases of children treated with intravesical oxybutynin chloride solution supplemented with hydroxypropylcellulose (modified intravesical oxybutynin) are described.
Highlights
IntroductionChildren with spinal cord disease (e.g. myelomeningocele, myelodysplasia, spina bifida, and spinal tumors) can present with neurogenic bladder, a condition in which the bladder partly or completely loses its ability to store urine and to void at low pressure
Children with spinal cord disease can present with neurogenic bladder, a condition in which the bladder partly or completely loses its ability to store urine and to void at low pressure
Early identification and treatment of children at high risk of urinary dysfunctions is needed in order to protect renal function and avoid urinary incontinence [3]
Summary
Children with spinal cord disease (e.g. myelomeningocele, myelodysplasia, spina bifida, and spinal tumors) can present with neurogenic bladder, a condition in which the bladder partly or completely loses its ability to store urine and to void at low pressure. The majority of children with neurogenic bladder (70-90%) respond well to oral anticholinergic agents with or without CIC [21] This therapeutic approach allows a high concentration of the drug to be delivered to the target tissue with the maximum pharmacological response and, theoretically, minimum AEs. the pharmacokinetic mechanisms of oxybutynin are not well known [22]. Guerra et al, based on their 8 reviews, revealed a significant reduction in pressure at maximum bladder capacity relative to conventional oral drug administration [29] They reviewed the effectiveness of intravesical oxybutynin precisely and investigated changes in the following scores; Maximum Bladder Capacity (MBC), pressure at MBC, bladder compliance, and the number of urinary incontinence. Intravesical oxybutynin is an effective treatment in patients who exhibit severe AEs or insufficient suppression of detrusor overactivity following oral anti-muscarinic pharmacotherapy. Greenfield and Ferra [8] Connor et al [32] Kasabian et al [6] Kaplinsky et al [10] Painter et al [43] Buyse et al [44] Ferrara et al [34] Guerra et al [45] Hayashi et al.* [30]
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