Combined intravesical and oral oxybutynin chloride in adult patients with spinal cord injury

Objectives. Detrusor hyperreflexia with elevated storage pressures presents a major risk factor for renal damage in patients with neurogenic lower uri nary tract dysfunction. If standard anticholinergic treatment is unsuccessf ul, surgical treatment must be considered. We evaluated the effects of intr avesical oxybutynin treatment an detrusor hyperreflexia in patients in whom standard oral treatment had failed. Methods. Twenty-five patients (mean age 36.7 years) with storage pressures greater than 40 cm H2O despite standard anticholinergic treatment received intravesical (15 mg three times daily) and oral oxybutynin chloride treatme nt. The follow-up evaluations included urodynamic testing, renal ultrasound , urine examination (urinalysis and urine culture), and evaluation of side effects. Results. The mean follow-up was 6 months. Intravesical treatment led to an increase in bladder storage volume from 349 to 420 mt. The mean maximum sto rage pressure was significantly reduced from 54 to 26.5 cm H2O. Detrusor st orage pressures returned to values less than 40 cm H2O in 21 of 25 patients . Dysreflexia was treated successfully in 3 of 5 patients. No patient devel oped renal damage. No severe side effects or drug-related discontinuation o f treatment were observed. Conclusions. Intravesical oxybutynin therapy seems to be a safe and effecti ve treatment option for detrusor hyperreflexia in adults and avoids surgica l treatment in most patients. Long-term observations concerning side effect s, acceptance, and efficacy are needed. (C) 2000, Elsevier Science Inc.