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.