Intravesical oxybutynin for spinal cord injury patients

Abstract

The treatment of choice for the failure to restore neurogenic bladder dysfunction, managed with clean intermittent catheterization program with incontinence, is anticholinergic medication. The goal is to increase bladder capacity, and decrease intravesical pressure in order to maintain continence between catheterizations. The most commonly used anticholinergic medication in the United States is Oxybutynin. Previous clinical studies have shown that 61% of the patients on oral Oxybutynin report adverse systemic side effects and are noncompliant in taking it. In 48% of the patients, possibly due to their noncompliance, oral Oxybutynin Hydrochloride is ineffective. In this study, 13 spinal cord injured patients with a failure to restore bladder dysfunction were treated with intravesical Oxybutynin. Nine patients improved on the regimen while one patient underwent surgical bladder augmentation. Postoperatively, this patient continued to be incontinent between catheterizations. Reinstitution of intravesical Oxybutynin stabilized the patient's bladder with clean intermittent catheterization without further intervention. After 3 months post instillation in the urodynamic studies, the mean bladder capacity increased, the mean volume at first contraction increased and the leak point pressure decreased. The decrease in leak point pressure was statistically significant. Leak point pressure is one of the most important parameters we monitor to preserve upper urinary tract function. We recommend the trial of intravesical Oxybutynin for patients who fit the criteria of the protocol prior to surgical bladder augmentation.