Effects of Oxybutynin on Vesicoureteral Reflux in Children

Abstract

We reviewed retrospectively 40 children seen from 1980 to 1984 with vesicoureteral reflux in 53 ureters. All patients had a hyperreflexic bladder on urodynamic evaluation with or without vesicoperineal dyssynergia but they were otherwise neurologically normal. All except 1 child received prophylactic antibiotics. Of the children 37 received oxybutynin therapy for bladder hyperreflexia for 3 to 18 months. Reflux disappeared or became grade I in 62.3 per cent of the ureters. Of the children manifesting urinary incontinence at the time of urodynamic study reflux disappeared or became grade I in 78.6 per cent. Reflux resolved or became grade I in 20 per cent of the children with no urinary incontinence. Of those patients with recurrent reflux at the onset of urinary incontinence and bladder instability reflux resolved or became grade I in 80 per cent. Oxybutynin therapy for hyperreflexic bladder resulted in an average increase in bladder capacity of 97 cc (54.2 per cent), which was maintained after cessation of treatment. These data suggest that bladder instability can be an important factor in causing and perpetuating reflux. Therapy aimed at decreasing intravesical pressure will enhance resolution or downgrading of reflux.

Follow-Up of Long-Time Treatment with Intravesical Oxybutynin for Neurogenic Bladder in Children

“…Noteworthy, these patients developed reflux despite ongoing CIC. This result is not as favorable as reported earlier [9] in patients with hyperreflexic bladders and VUR but without neurological impairment. However, their patients were followed for a protracted period of time before operation was performed when the reflux remained.…”

“…Among anticholinergic drugs, oxybutynin with its combined anticholinergic, smooth muscle relaxant and local anesthetic action [7] has been very effective with oral and intravesical administration [8, 9, 10, 11, 12, 13]. …”

Comprehensive Management of Dysfunctional Voiding

“…These results are similar to those shown by Homsy, who found that 78% of children improved to grade I or to no reflux after treatment with anticholinergic therapy. 15 Thirty percent of our patients had concomitant bowel complications. The co-morbidity of voiding dysfunction and soiling secondary to constipation has been well described.…”

Non-neuropathic bladder dysfunctions, and treatment approaches

“…Ayrıca, VUR ve sık İYE olan çocukların 1/3'inde görülmektedir (13) . AAM'nin antikolinerjik ile tedavisinin İYE sıklığını azalttığı ve kontrollere göre VUR rezolüsyonunu arttırdığı bilinmektedir (12,(14)(15)(16) .…”