Korean J Urol. 2007 Oct;48(10):1064-1068. Korean.
Published online Oct 31, 2007.
Copyright © 2007 The Korean Urological Association
Original Article

Efficacy and Tolerability of Extended-release Oxybutynin in Children with a Neurogenic Bladder

Jin Mo Um and Kwang Myung Kim
    • Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Received June 22, 2007; Accepted August 29, 2007.

Abstract

Purpose

The aim of this study was to investigate the efficacy and tolerability of extended-release oxybutynin (oxybutynin ER) in children with a neurogenic bladder.

Materials and Methods

Fifty-four patients (21 myelomeningocele and 33 lipomyelomeningocele) with a neurogenic bladder were enrolled in the study. We reviewed the medical records and performed a telephone interview. The treatments were changed from immediate-release oxybutynin (oxybutynin IR) or other anticholinergics to oxybutynin ER from August to December 2006. The mean age of the study patients was 11.1 years (range 4 to 18 years) and the mean body weight was 37.9kg (range 16.2 to 72.0kg). All patients were asked about the effectiveness, side effects and compliance with the medication. The number of voids, volume of urine per void or clean intermittent catheterization (CIC) and number of incontinence episodes were also evaluated.

Results

The mean duration of oxybutynin ER treatment was 16.3 weeks (range 7-25 weeks). Twenty-six patients (48.1%) responded they had improvement in voiding symptoms. Among the patients, there was a significant reduction in the number of incontinence episodes (from 3.3 to 1.3, p<0.001) with the change in medications. The number of voids or CIC per 24 hours and the maximum volume of urine per void or CIC did not show a significant change. Another twenty-eight patients (51.9%) responded that the improvements were maintained. Among these patients, there were no significant changes of the medications. Only five patients (9.3%) changed their medication because of the side effects.

Conclusions

The results of this study showed that the extended-release oxybutynin was effective and well tolerated in children with a neurogenic bladder.

Keywords
Oxybutynin; Children; Neurogenic bladder

Figures

Fig. 1
The efficacy of extended-release oxybutynin. In this group, the patients said they experienced improvement in efficacy after the medication was changed from other anticholinergics to the extended-release oxybutynin (p>0.05 except incontinence).

Fig. 2
The efficacy of extended-release oxybutynin. In this group, the patients said they experienced maintenance of the improved efficacy after the medication change from other anticholinergics to the extended-release oxybutynin (p>0.05).

Fig. 3
Compliance with extended-release oxybutynin.

Fig. 4
Flow chart of the medication changes.

Tables

Table 1
Side effects of extended-release oxybutynin

Table 2
Comparison of efficacy and side effects of the extended-release oxybutynin (oxybutynin ER) between the patients who could use immediate-release oxybutynin (oxybutynin IR) and the patients who could not

References

    1. Yoshimura N, Chancellor MB. Current and future pharmacological treatment for overactive bladder. J Urol 2002;168:1897–1913.
    1. Baskin LS, Kogan BA, Benard F. Treatment of infants with neurogenic bladder dysfunction using anticholinergic drugs and intermittent catheterisation. Br J Urol 1990;66:532–534.
    1. Kasabian NG, Bauer SB, Dyro FM, Colodny AH, Mandell J, Retik AB. The prophylactic value of clean intermittent catheterization and anticholinergic medication in newborns and infants with myelodysplasia at risk of developing urinary tract deterioration. Am J Dis Child 1992;146:840–843.
    1. Park JM, Bauer SB, Freeman MR, Peters CA. Oxybutynin chloride inhibits proliferation and suppresses gene expression in bladder smooth muscle cells. J Urol 1999;162:1110–1114.
    1. Appel RA. Oxybutynin. The clinical experience. Contemp Urol 1991;3:60–67.
    1. Yarker YE, Goa KL, Fitton A. Oxybutynin. A review of its pharmacodynamic and pharmacokinetic properties and its therapeutic use in detrusor instability. Drugs Aging 1995;6:243–262.
    1. Massad CA, Kogan BA, Trigo-Rocha FE. The pharmacokinetics of intravesical and oral oxybutynin chloride. J Urol 1992;148:595–597.
    1. Kasabian NG, Vlachiotis JD, Lais A, Klumpp B, Kelly MD, Siroky MB, et al. The use of intravesical oxybutynin chloride in patients with detrusor hypertonicity and detrusor hyperreflexia. J Urol 1994;151:944–945.
    1. Palmer LS, Zebold K, Firlit CF, Kaplan WE. Complications of intravesical oxybutynin chloride therapy in the pediatric myelomeningocele population. J Urol 1997;157:638–640.
    1. Siddiqui MA, Perry CM, Scott LJ. Oxybutynin extended-release: a review of its use in the management of overactive bladder. Drugs 2004;64:885–912.
    1. Anderson R, Mobley D, Blank B, Saltzstein D, Susset J, Brown JS. OROS Oxybutynin Study Group. Once daily controlled versus immediate release oxybutynin chloride for urge urinary incontinence. J Urol 1999;161:1809–1812.
    1. Versi E, Appell R, Mobley D, Patton W, Saltzstein D. The Ditropan XL Study Group. Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. Obstet Gynecol 2000;95:718–721.
    1. Gleason DM, Susset J, White C, Munoz DR, Sand PK. Ditropan XL Study Group. Evaluation of a new once-daily formulation of oxybutynin for the treatment of urinary urge incontinence. Urology 1999;54:420–423.
    1. Youdim K, Kogan BA. Preliminary study of the safety and efficacy of extended-release oxybutynin in children. Urology 2002;59:428–432.
    1. Reinberg Y, Crocker J, Wolpert J, Vandersteen D. Therapeutic efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with diurnal urinary incontinence. J Urol 2003;169:317–319.
    1. Kaefer M, Pabby A, Kelly M, Darbey M, Bauer SB. Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomeningocele. J Urol 1999;162:1068–1071.
    1. Thompson IM, Lauvetz R. Oxybutynin in bladder, spasm, neurogenic bladder and enuresis. Urology 1976;8:452–454.
    1. Nijman RJ. Classification and treatment of functional incontinence in children. BJU Int 2000;85 Suppl 3:37–42.
    1. Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol 2004;3:46–53.
    1. Douchamps J, Derenne F, Stockis A, Gangji D, Juvent M, Herchuelz A. The pharmacokinetics of oxybutynin in man. Eur J Clin Pharmacol 1988;35:515–520.
    1. Gupta S, Sathyan G. Pharmacokinetics of an oral once-a-day controlled-release oxybutynin formulation compared with immediate release oxybutynin. J Clin Pharmacol 1999;39:289–296.
    1. Autret E, Jonville AP, Dutertre JP, Bertiere MC, Robert M, Averous M, et al. Plasma levels of oxybutynin chloride in children. Eur J Clin Pharmacol 1994;46:83–85.
    1. Eisen SA, Miller DK, Woodward RS, Spitznagel E, Przybeck TR. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med 1990;150:1881–1884.
    1. Paes AH, Bakker A, Soe-Agnie CJ. Impact of dosage frequency on patient compliance. Diabetes Care 1997;20:1512–1517.

Metrics
Share
Figures

1 / 4

Tables

1 / 2

PERMALINK