TREATMENT OF NEUROGENIC BLADDER DYSFUNCTION IN INFANTS AND CHILDREN WITH NEUROSPINAL DYSRAPHISM WITH CLEAN INTERMITTENT (SELF)CATHETERISATION AND OPTIMIZED INTRAVESICAL OXYBUTYNIN HYDROCHLORIDE THERAPY

Clean intermittent (self)catheterisation (CIC) in combination with ora l anticholinergic drugs (oxybutynin hydrochloride [OH]) is the present standard therapy for neurogenic bladder dysfunction (NBD) with detrus or hyperactivity. However, complete suppression of detrusor contractio ns and complete urinary continence is not always obtained despite maxi mal dosage, and the high incidence of severe systemic anticholinergic side-effects often impairs therapeutic compliance, resulting in dose r eduction or even discontinuation of therapy. The intravesical administ ration of OH has been shown recently to be an effective alternative fo r treating persistent detrusor hyperactivity, and occurrence and sever ity of systemic side-effects appeared to be significantly decreased. H owever, available data are limited from a paediatric view. Furthermore , it is our belief that the use of crushed OH tablets with consequent problems of impracticability accounts for the variable long-term patie nt compliance reported to be the only disadvantage to intravesical OH. Using an optimized drug preparation we demonstrate the superiority of intravesical OH for treatment of NBD in 15 children (range 0.6-13.75 years, mean 6.1) with incomplete detrusor activity suppression and/or intolerable systemic side-effects on oral OH therapy. Since the previo us reported problems of impracticability and variable long-term patien t compliance can be resolved by optimized drug preparation, we therefo re conclude that the era of crushing OH tablets should be over in orde r to allow the intravesical OH therapy on a long-lasting and large-sca le basis.