No abstract

Objective: We prospectively analyzed the dose dependent outcome and side eects of neurogenic bladder patients with intravesical application of oxybutynin at our centre. Materials and methods: We examined the data of 32 patients with neurogenic bladders and detrusor hyperre¯exia. We registered clinical outcome, continence situation, side eects and urodynamic data of patients with (A) standard dosages of intravesical oxybutynin (0.3 mg/kg bodyweight per day) and (B) with increasing dosages in steps of 0.2 mg/kg bodyweight per day up to 0.9 mg/kg bodyweight per day. Results: We examined 32 patients aged 1 to 34 years, mean age 12 years. 21/32 patients became totally continent with the dosage (A). They showed a signi®cant (P50.01) decrease in the median max detrusor pressure (MDP) and a signi®cant (P50.01) increase in the median compliance and the median age adjusted bladder capacity (AABC). Eleven out of 32 patients remained incontinent under this dosage (A). Their median MDP, their median compliance and their median AABC remained nearly unchanged. Seven out of 11 incontinent patients under dosage (A) were treated eciently with the higher dosages (B). Their median necessary dosage escalation to achieve treatment success was 0.7 mg/kg bodyweight per day (range 0.5 to 0.9 mg/kg bodyweight per day). Their median MDP was signi®cantly (P50.05) decreased and their median compliance and median AABC were signi®cantly (P50.05) increased. Four out of 11 patients remained incontinent and showed only little improvement in urodynamic data. Two out of 11 patients with the dosage escalation (B) showed side eects at a dosage of 0.9 mg/kg bodyweight per day. Conclusions: The intravesical application of oxybutynin was a well tolerated and ecacious therapy. The topical oxybutynin therapy dosage (A) was ecient in 66% of our selected patients, the escalating dosage titration (B) could increase the eciency to 87%. Spinal Cord (2000) 38, 250 ± 254

Our data suggest that endoscopic subureteral collagen injection in neurogenic bladder cases is not effective with long-term followup. New biocompatible and biodegradable materials should be tested to control vesicoureteral reflux.

The mechanical principle of function of the Harrington instruments or of the spinal stabilization by means of plates does not meet the anatomical and mechanical conditions in instable fractures of the thoracic and lumbar spine sufficiently. The requested qualities in regard to fixation of the material, shortness of fusion distance, possibility of reduction and variability according to individual situations can be met only by the fixateur externe. Magerl was able to verify the correctness of this thesis by means of the fixateur externe constructed by himself. It was logic for us to practice the mechanical principle of the fixateur externe in using the implantation instruments which were positioned directly to the spine. The first instruments of this kind were introduced by Dick in 1983 and were used in Bad Wildungen since November 1983 successfully. The practical experiences of more than 40 operations using the Dick fixateur interne resulted in the development of own instruments applied by us since the beginning of 1985 as preliminary prototypes.