INTRAVESICAL THERAPY FOR THE TREATMENT OF NEUROGENIC BLADDER IN CHILDREN

Oral pharmacotherapy has been commonly used as an adjunct to clean int ermittent catheterization (CIC) in the treatment of neurogenic bladder in order to achieve continence, but may be associated with unacceptab le side effects. The authors' experience with sterile intravesical pre parations of oxybutynin hydrochloride and ephedrine in children is rep orted here. Methods: Patients requiring CIC for neurogenic bladder but with incontinence that was unresponsive to standard oral therapy or t hat was associated with severe systemic side effects were studied over a I-year period. Clinical, radiological and urodynamic assessments we re made prior to commencing treatment with intravesical oxybutynin hyd rochloride. Patients who remained incontinent with poor internal sphin cter muscle tone had intravesical ephedrine added. Results: Seven pati ents were involved in the study over a I-year period. Two patients bec ame continent and one patient had an improvement in upper tract dilata tion. One patient had a limited improvement with oxybutynin alone but became continent with the addition of ephedrine. Three patients had no response to treatment. There were few side effects. Conclusion: Intra vesical agents have a role in the management of paediatric neurogenic bladder for those children with significant adverse sequelae from oral pharmacotherapy who would otherwise require surgical intervention. In travesical therapy is a safe technique in children with sterile prepar ations. Further investigation of this modality should be pursued.