URODYNAMIC EFFECTS OF ORAL OXYBUTYNIN CHLORIDE IN CHILDREN WITH MYELOMENINGOCELE AND DETRUSOR HYPERREFLEXIA

Objectives. To investigate the effects of oral oxybutynin chloride (OC ) on standard urodynamic measures in children with myelomeningocele (M MC) and detrusor hyperreflexia. Methods, Forty-one MMC children with d etrusor hyperreflexia (19 boys and 22 girls, aged 2 months to 15 years ; mean 4.9 years) were evaluated urodynamically before and within 3 mo nths after initiation of oral OC therapy (0.2 to 0.3 mg/kg/day). Thera py with oral OC was always combined with clean intermittent catheteriz ation (CIC). Results. Oral OC treatment caused an increase in bladder capacity from 141 +/- 96 to 197 +/- 99 mL (+40%; P<0.01), a decrease i n detrusor pressure at maximal capacity from 45 +/- 32 to 28 +/- 23 cm H2O (-38%; P<0.01), and an increase in detrusor compliance from 6.5 /- 5.6 to 16.8 +/- 13.7 mL/cm H2O (+158%; P<0.01). Improvement in urod ynamic measures and continence were correlated. After a follow-up of a t least 2 years, effective protection of renal function was achieved i n 38 of the 41 children (93%) with conservative therapy alone. Adverse effects resulted in discontinuation of oral OC treatment in only 2 ca ses. Conclusions. Treatment with oral OC and CIC is effective and safe in children with MMC and detrusor hyperreflexia and should be initiat ed early when indicated by urodynamic findings. (C) 1998, Elsevier Sci ence Inc. All rights reserved.