Wirkung oraler Oxybutyninhydrochloridgaben auf urodynamische Parameter von Kindern mit Myelomeningozele und Detrusorhyperreflexie

The effect of oral oxybutynin chloride (OH) on urodynamic parameters was investigated in 30 children (14 m, 16 f; age 11 months to 15 years, mean age 4.5 years) with myelomeningocele (MMC) and detrusor hyperreflexia. The dose of OH was 0.2-0.3 mg/kg TID-QID with all patients set on concomitant intermittent catheterization. Patients were reevaluated urodynamically within 3 months while on OH medication. Mean bladder capacity increased from 132 ± 92 ml to 190 ± 95 ml (+ 44%; p < 0.01). Detrusor pressure at maximum capacity decreased from 44 ± 34cm H₂O to 33 ± 25 cm H₂O (- 25%; p < 0.05). Detrusor compliance increased from 6.7 ± 6.1 ml/cm H₂O to 15.4 ± 13.9 ml/cm H₂O (+ 130%; p < 0.01). Improvement of urodynamic parameters correlated with improvement of continence. In one case intravesical instillation of OH was initiated because of side effects from oral medication. In a follow-up interval of at least 2 years an effective protection of renal function was achieved in 29 out of 30 children (97%) with conservative therapy alone. We conclude that treatment with oral OH and intermittent catheterization, based on urodynamic findings, is effective and safe in children with MMC and detrusor hyperreflexia. Therefore, it should be started early when indicated by urodynamic findings.

Key words:

Meningomyelocele - Detrusor hyperreflexia - Oxybutynin chloride - Oral - Urodynamic