Haferkamp A, Staehler G, Gerner H J, Dörsam J
Department of Urology, University of Heidelberg, Germany.
Spinal Cord. 2000 Apr;38(4):250-4. doi: 10.1038/sj.sc.3100995.
We prospectively analyzed the dose dependent outcome and side effects of neurogenic bladder patients with intravesical application of oxybutynin at our centre.
We examined the data of 32 patients with neurogenic bladders and detrusor hyperreflexia. We registered clinical outcome, continence situation, side effects and urodynamic data of patients with (A) standard dosages of intravesical oxybutynin (0.3 mg/kg bodyweight per day) and (B) with increasing dosages in steps of 0.2 mg/kg bodyweight per day up to 0.9 mg/kg bodyweight per day.
We examined 32 patients aged 1 to 34 years, mean age 12 years. 21/32 patients became totally continent with the dosage (A). They showed a significant (P<0.01) decrease in the median max detrusor pressure (MDP) and a significant (P<0.01) increase in the median compliance and the median age adjusted bladder capacity (AABC). Eleven out of 32 patients remained incontinent under this dosage (A). Their median MDP, their median compliance and their median AABC remained nearly unchanged. Seven out of 11 incontinent patients under dosage (A) were treated efficiently with the higher dosages (B). Their median necessary dosage escalation to achieve treatment success was 0.7 mg/kg bodyweight per day (range 0.5 to 0.9 mg/kg bodyweight per day). Their median MDP was significantly (P<0.05) decreased and their median compliance and median AABC were significantly (P<0.05) increased. Four out of 11 patients remained incontinent and showed only little improvement in urodynamic data. Two out of 11 patients with the dosage escalation (B) showed side effects at a dosage of 0. 9 mg/kg bodyweight per day.
The intravesical application of oxybutynin was a well tolerated and efficacious therapy. The topical oxybutynin therapy dosage (A) was efficient in 66% of our selected patients, the escalating dosage titration (B) could increase the efficiency to 87%.
我们前瞻性分析了在本中心膀胱内应用奥昔布宁治疗神经源性膀胱患者的剂量依赖性疗效和副作用。
我们检查了32例神经源性膀胱伴逼尿肌反射亢进患者的数据。我们记录了（A）膀胱内应用标准剂量奥昔布宁（每天0.3mg/kg体重）和（B）每天以0.2mg/kg体重递增剂量直至0.9mg/kg体重的患者的临床疗效、控尿情况、副作用和尿动力学数据。
我们检查了32例年龄在1至34岁之间、平均年龄12岁的患者。21/32例患者使用剂量（A）后完全控尿。他们的最大逼尿肌压力中位数（MDP）显著降低（P<0.01），顺应性中位数和年龄校正膀胱容量中位数（AABC）显著增加（P<0.01）。32例患者中有11例在该剂量（A）下仍有尿失禁。他们的MDP中位数、顺应性中位数和AABC中位数几乎没有变化。剂量（A）下11例尿失禁患者中有7例使用更高剂量（B）治疗有效。他们达到治疗成功所需的剂量中位数递增至每天0.7mg/kg体重（范围为每天0.5至0.9mg/kg体重）。他们的MDP中位数显著降低（P<0.05），顺应性中位数和AABC中位数显著增加（P<0.05）。11例患者中有4例仍有尿失禁，尿动力学数据仅略有改善。11例剂量递增（B）的患者中有2例在每天0.9mg/kg体重的剂量下出现副作用。
膀胱内应用奥昔布宁是一种耐受性良好且有效的治疗方法。局部应用奥昔布宁治疗剂量（A）在我们所选患者中66%有效，递增剂量滴定（B）可将有效率提高至87%。
