Long-Term Intravesical Oxybutynin Chloride Therapy in Children with Myelodysplasia

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Abstract
We evaluated the clinical use of long-term intravesical oxybutynin chloride in the treatment of neurogenic bladder dysfunction in children with myelodysplasia who could not tolerate oral anticholinergics. We retrospectively reviewed the records of all patients recommended for intravesical oxybutynin chloride therapy. A total of 12 girls and 18 boys 1 to 17 years old was recruited for study. Oxybutynin chloride (5 mg.) was instilled 2 times daily and pretreatment cystograms were compared to followup urodynamic studies. Duration of therapy was 2 to 26 months (mean 13, median 12). Mean total capacity plus or minus standard deviation increased from 209 plus/minus 103 to 282 plus/minus 148 ml. (p less than 0.01), mean safe capacity increased from 157 plus/minus 105 to 234 plus/minus 147 ml. (p less than 0.01) and mean age adjusted safe capacity increased from 76 plus/minus 36 to 115 plus/minus 62 percent. Of the 29 patients who were incontinent 3 (10 percent) achieved continence and 19 (65 percent) reported a decreased use of sanitary pads. None of the patients had systemic side effects related to intravesical treatment. We believe that intravesical oxybutynin chloride is a viable treatment option for patients with myelodysplasia in whom oral therapy fails.