INTRAVESICAL OXYBUTYNIN CHLORIDE AND CLEAN INTERMITTENT CATHETERIZATION IN PATIENTS WITH NEUROGENIC VESICAL DYSFUNCTION AND DECREASED BLADDER CAPACITY

Oral administration of oxybutynin chloride is effective in increasing bladder capacity in patients with neurogenic bladder dysfunction who a re practising clean intermittent catheterisation, but it is often asso ciated with systemic side effects. The eff ect of intravesical instill ation of oxybutynin chloride was studied in 14 patients who were pract ising clean intermittent catheterisation and in whom the maximum cysto metric capacity was < 250 ml and/or vesical compliance < 5. A 5-mg tab let of oxybutynin chloride was crushed and suspended in 10 ml of boile d and cooled water and instilled into the bladder after emptying it co mpletely; this was carried out thrice daily either by the patient or b y his carer. During follow-up (6-12 months) no local or systemic side effects were observed and patient compliance was excellent in 12 patie nts, who showed an increase in maximum cystometric capacity and vesica l compliance. One patient could not retain the drug intravesically bec ause of reflex detrusor contraction and he was excluded from the study . One patient was lost to follow-up. The results suggest that the intr avesical instillation of oxybutynin chloride is safe and effective in the treatment of selected patients with neurogenic bladder dysfunction whose bladder capacity is small and who are practising clean intermit tent catheterisation.