INTRAVESICAL APPLICATION OF A STABLE OXYBUTYNIN SOLUTION IMPROVES THERAPEUTIC COMPLIANCE AND ACCEPTANCE IN CHILDREN WITH NEUROGENIC BLADDERDYSFUNCTION

Purpose: To improve patient compliance with and acceptance of intraves ical oxybutynin therapy for neurogenic bladder dysfunction we develope d a stable oxybutynin solution that eliminates the complicated crushin g procedure. Materials and Methods: From January 1995 to January 1997 we prospectively evaluated 15 children with a mean age of 6.1 years wi th persistent detrusor hyperactivity or significant side effects on or al oxybutynin therapy who received intravesically 0.2 mg./kg. (maximum 5 mg.) of a stable oxybutynin solution (5 mg./5 ml., pH 5.85) twice d aily. Results: The oxybutynin solution remained stable up to 24 months . In 13 of the 15 children therapeutic compliance was excellent. Detru sor hyperactivity decreased and systemic side effects were absent or m inimal. After 4 and 24 months mean cystometric bladder capacity plus o r minus standard error of mean increased from 114 +/- 15.2 to 161 +/- 26.6 and 214 +/- 21.7 ml. (p <0.01), mean ratio of cystometric-to-expe cted bladder capacity increased from 0.88 +/- 0.12 to 1.18 +/- 0.14 an d 1.24 +/- 0.16 (p <0.01), and end filling bladder pressure decreased from 57.0 +/- 7.1 to 25.6 +/- 4.4 and 30.8 +/- 4.4 cm. water (p <0.01) , respectively. Conclusions: Intravesical instillation of a specially prepared oxybutynin solution is safe and reliable in children with per sistent detrusor hyperactivity or side effects on oral oxybutynin ther apy. Eliminating the complex crushing preparation of the solution by t he child or parent has made this therapy easy to use and acceptable in the long term.