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Detrusor overactivity in spina bifida: how long does it need to be treated?
Neurourol Urodyn. 2004; 23(7):685-8.NU

Abstract

AIMS

To determine whether a lasting therapeutic effect can be expected from long-term antimuscarinic therapy for neurogenic detrusor overactivity in spina bifida and to answer the question whether detrusor overactivity in spina bifida children with detrusor/sphincter dyssynergia is primarily based on the neuropathy or, in part, can be a secondary detrusor reaction to the functional urethral obstruction.

METHODS

Fifteen spina bifida patients, aged between 1 and 12 years, all on a regime of clean intermittent catheterisation (CIC) and oxybutynin since shortly after birth, underwent three consecutive urodynamic studies (UDS). One prestudy UDS for treatment control, one UDS after withdrawal of oxybutynin for 3-5 days and one UDS after reinstallment of oxybutynin treatment. Urodynamic results were compared concerning detrusor overactivity, cystometric bladder capacity, and compliance.

RESULTS

Detrusor overactivity was seen in two patients on the prestudy UDS. After several days of withdrawal of oxybutynin overactivity was seen in 11 patients. After oxybutynin withdrawal, bladder compliance was within safe margins for two patients only, after reinstallment, safe vesical pressures were seen in 11 patients.

CONCLUSION

The functional obstruction due to detrusor/sphincter dyssynergia has been by-passed chronically in all these children by CIC and oxybutynin. Due to the fact that detrusor overactivity recurs immediately after withdrawal of medication after long-term treatment with oxybutynin, one can conclude that there is no long-lasting therapeutic effect of pharmacological suppression. This suggests that in children with detrusor/sphincter dyssynergia, detrusor overactivity is primarily of neuropathic origin.

Authors+Show Affiliations

Department of Pediatric Urology, Children's Hospital, University Medical Center Utrecht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15382196

Citation

Ab, Elisabeth, et al. "Detrusor Overactivity in Spina Bifida: How Long Does It Need to Be Treated?" Neurourology and Urodynamics, vol. 23, no. 7, 2004, pp. 685-8.
Ab E, Dik P, Klijn AJ, et al. Detrusor overactivity in spina bifida: how long does it need to be treated? Neurourol Urodyn. 2004;23(7):685-8.
Ab, E., Dik, P., Klijn, A. J., van Gool, J. D., & de Jong, T. P. (2004). Detrusor overactivity in spina bifida: how long does it need to be treated? Neurourology and Urodynamics, 23(7), 685-8.
Ab E, et al. Detrusor Overactivity in Spina Bifida: How Long Does It Need to Be Treated. Neurourol Urodyn. 2004;23(7):685-8. PubMed PMID: 15382196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detrusor overactivity in spina bifida: how long does it need to be treated? AU - Ab,Elisabeth, AU - Dik,Pieter, AU - Klijn,Aart J, AU - van Gool,Jan D, AU - de Jong,Tom P V M, PY - 2004/9/24/pubmed PY - 2004/12/16/medline PY - 2004/9/24/entrez SP - 685 EP - 8 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 23 IS - 7 N2 - AIMS: To determine whether a lasting therapeutic effect can be expected from long-term antimuscarinic therapy for neurogenic detrusor overactivity in spina bifida and to answer the question whether detrusor overactivity in spina bifida children with detrusor/sphincter dyssynergia is primarily based on the neuropathy or, in part, can be a secondary detrusor reaction to the functional urethral obstruction. METHODS: Fifteen spina bifida patients, aged between 1 and 12 years, all on a regime of clean intermittent catheterisation (CIC) and oxybutynin since shortly after birth, underwent three consecutive urodynamic studies (UDS). One prestudy UDS for treatment control, one UDS after withdrawal of oxybutynin for 3-5 days and one UDS after reinstallment of oxybutynin treatment. Urodynamic results were compared concerning detrusor overactivity, cystometric bladder capacity, and compliance. RESULTS: Detrusor overactivity was seen in two patients on the prestudy UDS. After several days of withdrawal of oxybutynin overactivity was seen in 11 patients. After oxybutynin withdrawal, bladder compliance was within safe margins for two patients only, after reinstallment, safe vesical pressures were seen in 11 patients. CONCLUSION: The functional obstruction due to detrusor/sphincter dyssynergia has been by-passed chronically in all these children by CIC and oxybutynin. Due to the fact that detrusor overactivity recurs immediately after withdrawal of medication after long-term treatment with oxybutynin, one can conclude that there is no long-lasting therapeutic effect of pharmacological suppression. This suggests that in children with detrusor/sphincter dyssynergia, detrusor overactivity is primarily of neuropathic origin. SN - 0733-2467 UR - https://www.unboundmedicine.com/medline/citation/15382196/Detrusor_overactivity_in_spina_bifida:_how_long_does_it_need_to_be_treated L2 - https://doi.org/10.1002/nau.20044 DB - PRIME DP - Unbound Medicine ER -