COMPLICATIONS OF INTRAVESICAL OXYBUTYNIN CHLORIDE THERAPY IN THE PEDIATRIC MYELOMENINGOCELE POPULATION

Purpose: We report our experience with the intravesical administration of oxybutynin chloride with particular focus on the incidence and cha racterization of untoward effects and inconvenience of therapy. Materi als and Methods: From 1990 to 1995, 23 children 5 to 11 years old with myelodysplasia were treated with intravesical oxybutynin chloride. In itial dose was 1.25 mg. in 5 cc sterile water instilled during routine catheterization 3 times daily, which was increased as tolerated and c linically indicated. Oral anticholinergic, antispasmodic and sympathom imetic medications were discontinued during therapy. We reviewed thera peutic indications, doses, frequency, duration, reason for discontinua tion and untoward effects. Patients/parents were surveyed for convenie nce of treatment as well as side effects and their timing with respect to drug administration and dose. Results: In 15 patients (65%) treatm ent was discontinued and oral formulations were resumed or other thera py was required due to side effects, ineffectiveness or inconvenience. Seven patients had untoward effects, ranging from facial flushing and dizziness to agoraphobia and hyperactivity. Six patients discontinued therapy due to side effects after 1 day to 2 years (mode 1 month) at doses of 1.25 to 5 mg., including 5 who previously had side effects fr om oral oxybutynin chloride. Inconvenience of therapy was noted irresp ective of the degree of independence of the child for performing intra vesical therapy. Conclusions: Untoward effects and inconvenience are t he most common reasons for discontinuing intravesical oxybutynin chlor ide therapy for neurogenic bladder dysfunction. Children who previousl y had side effects from oral oxybutynin chloride are more likely to ha ve them during intravesical therapy.