We evaluated the efficacy and safety of transdermal and oral oxybutynin in children with neurogenic detrusor overactivity.
Children with neurogenic detrusor overactivity 6 to 15 years old and previously receiving oxybutynin were assigned randomly at a 3:1 ratio to treatment with transdermal or oral oxybutynin. Initial dosages (transdermal 1.3, 2.9 or 3.9 mg daily; oral 5, 10 or 15 mg daily), based on pre-study dosages, were adjusted after 2 weeks and then maintained for 12 weeks. The primary efficacy end point was change from baseline to last observation in average urine volume collected by clean intermittent catheterization.
A total of 57 patients were randomized to receive transdermal (41) or oral (16) oxybutynin. Safety data were available for 55 patients and efficacy data were available for 52. Mean +/- SD urine volume increased from 95 +/- 64 ml to 125 +/- 74 ml (p <0.001) with transdermal oxybutynin and from 114 +/- 75 ml to 166 +/- 92 ml (p = 0.002) with oral oxybutynin. Transdermal oxybutynin resulted in significant improvement in all measured urodynamic parameters. Similar trends and a significant increase in maximal cystometric bladder capacity were observed in the smaller oral oxybutynin group. There were 12 treatment related adverse events noted with transdermal oxybutynin (mild skin reaction) and 1 with oral oxybutynin (vasodilatation). The ratio of N-desethyloxybutynin-to-oxybutynin plasma concentrations was substantially lower with transdermal (1.4) than with oral (6.7) oxybutynin.
Transdermal oxybutynin was a well tolerated and effective alternative to oral oxybutynin in treating neurogenic detrusor overactivity in children who previously tolerated oxybutynin.
"Because the human detrusor contains only M2 and M3 muscarinic receptor subtypes , M2 and M3 receptor-specific antimuscarinics reduce the side effects of nonselective antimuscarinic drugs that bind to M1, M2, and M3 receptors . In addition, oral sustained-release formulations, transdermal or intravesical instillation, and a combination of different antimuscarinic drugs have been found to be helpful to reduce antimuscarinic side effects [27,76-78]. "
[Show abstract][Hide abstract] ABSTRACT: The proper performance of the lower urinary tract is dependent on an intact neural innervation of the individual structures involved. Therefore, any congenital neurological anomalies, diseases, or lesions of the central, peripheral, or autonomic nervous systems can result in lower urinary tract symptoms. Lower urinary tract dysfunction (LUTD) secondary to neurological disorders can significantly reduce quality of life (QoL) and may also give rise to serious complications and psychological and social sequelae. The goals of management of LUTD in patients with neurological disorders are to prevent serious complications and to improve the patient's QoL. Understanding the physiology and pathophysiology of micturition is critical to selecting appropriate treatment options. This article provides an overview of the clinical characteristics, diagnosis, and management of LUTD in patients with certain central and peripheral neuropathies and common lesions.
Korean journal of urology 09/2012; 53(9):583-92. DOI:10.4111/kju.2012.53.9.583
[Show abstract][Hide abstract] ABSTRACT: The nonsurgical management of patients with spina bifida is predicated on maintaining a compliant bladder of adequate size or correcting detrusor sphincter dyssynergy that can lead to progressive bladder damage and ultimately upper tract changes. Pharmacologic management, targeted at the detrusor and/or external sphincter, can be done. Neuromodulation using transcutaneous approaches with interferential electrostimulation, sacral (S2-S3) via digital transcutaneous electrical nerve stimulation, and percutaneous tibial nerve stimulation all have shown varied successes.
Current Urology Reports 03/2010; 11(2):109-13. DOI:10.1007/s11934-010-0096-6 · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several studies have investigated the many pharmacologic therapies to treat neurogenic bladder. Our aim with this review is
to provide an update on the current clinical and basic science literature pertaining to pharmacotherapy for this condition.
Advances have been made in pediatric and adult pharmacotherapy. The most notable include the safety and effective use of tolterodine
and transdermal oxybutynin in the treatment of pediatric neurogenic bladder. Also, recently, the safe and effective triple
drug therapy consisting of an antimuscarinic, an α-blocker, and imipramine in combination has been shown to significantly
improve bladder compliance and detrusor pressures.
KeywordsNeurogenic bladder-Antimuscarinic agents-Spinal cord injury-Multiple sclerosis
Current Bladder Dysfunction Reports 06/2010; 5(2):63-70. DOI:10.1007/s11884-010-0046-7
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