INTRAVESICAL OXYBUTYNIN FOR SPINAL-CORD INJURY PATIENTS

The treatment of choice for the failure to restore neurogenic bladder dysfunction, managed with clean intermittent catheterization program w ith incontinence, is anticholinergic medication. The goal is to increa se bladder capacity, and decrease intravesical pressure in order to ma intain continence between catheterizations. The most commonly used ant i-cholinergic medication in the United States is Oxybutynin. Previous clinical studies have shown that 61% of the patients on oral Oxybutyni n report adverse systemic side effects and are noncompliant in taking it. In 48% of the patients, possibly due to their noncompliance, oral Oxybutynin Hydrochloride is ineffective.(1,2) In this study, 13 spinal cord injured patients with a failure to restore bladder dysfunction w ere treated with intravesical Oxybutynin. Nine patients improved on th e regimen while one patient underwent surgical bladder augmentation. P ostoperatively, this patient continued to be incontinent between cathe terizations. Reinstitution of intravesical Oxybutynin stabilized the p atient's bladder with clean intermittent catheterization without furth er intervention. After 3 months post instillation in the urodynamic st udies, the mean bladder capacity increased, the mean volume at first c ontraction increased and the leak point pressure decreased. The decrea se in leak point pressure was statistically significant. Leak point pr essure is one of the most important parameters we monitor to preserve upper urinary tract function. We recommend the trial of intravesical O xybutynin for patients who fit the criteria of the protocol prior to s urgical bladder augmentation.