The effects of long-term medical treatment combined with clean intermittent catheterization in children with neurogenic detrusor overactivity.

OBJECTIVES

To assess whether conservative treatment of pediatric patients with neurogenic detrusor overactivity (NDO) results in lower bladder pressure and increased expected bladder volume (EBV), we investigated the clinical and urodynamic effects of long-term intravesical oxybutynin instillation compared with a standard treatment of oral anticholinergic medication in patients with clean intermittent catheterization (CIC).

METHODS

A retrospective study was performed including 21 patients suffering from myelomeningocele and NDO. Initially, all patients were treated with oral anticholinergics and CIC. Ten of the 21 patients showed a sufficient response to the treatment and were included in group I (anticholinergics and CIC). The other 11 patients responded poorly to the initial treatment or developed side effects to oral medication. These patients were included in group II and treated with intravesical oxybutynin and CIC. The two groups were compared using clinical, sonographic and urodynamic examinations performed prior to starting treatment and repeated on an annual basis. Changes from baseline were analyzed with the Mann-Whitney U test.

RESULTS

Ten patients in group I and 11 in group II were investigated. Two of the 11 patients in group II stopped the treatment. The mean starting age was 8.1 (± 6.6) years in group I and 12.5 (± 4.5) years in group II. The mean follow-up time was 7.1 (± 5.5) years in group I and 3.6 (± 1.8) years in group II. Bladder capacity increased from 173 (± 99) to 371 (± 115) ml in group I and from 245 (± 133) to 370 (± 156) ml in group II. Six of the 10 patients in group I and 6/9 patients in group II reached normal EBV. Three of the 10 subjects in group I and 6/9 in group II had bladder compliance values >10 ml/cm H(2)O. At final follow-up, the overall rate of urinary tract infections was equal. Social continence was achieved in 6/10 in group I and 7/9 in group II. Altogether, 19/21 patients responded to conservative management.

CONCLUSIONS

In children with NDO, conservative medical treatment combined with CIC is feasible and provides an improved pattern of bladder function, which could help avoid bladder surgery.