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At least 1,675 records · Page 93Linked to original sources
PubMed1994

Early cystometrograms can predict the response to intravesical instillation of oxybutynin chloride in myelomeningocele patients.

Recent reported experiences with intravesical medications in neurogenic bladder patients prompted us to evaluate this form of therapy in 28 myelomeningocele patients who could not tolerate oral anticholinergic agents or did not have adequate control on these agents. A pretreatment cystometrogram was performed followed by intravesical administration of oxybutynin chloride, with a repeat cystometrogram 3 hours later. Patients then began twice daily intravesical oxybutynin for a minimum of 4 months. The mean bladder capacity increased by 41%, the mean intravesical pressure decreased by 47% and compliance improved. Five patients achieved continence and 62% had less wetting while on intravesical therapy. The immediate posttreatment cystometrogram was predictive of the response to intravesical therapy on followup studies. Unfortunately, patient compliance was poor, with only 13 of the 28 patients remaining on therapy for the duration of the study.

Administration, Intravesical↗
PubMed1993

Topical effect of intravesical oxybutynin.

Intravesical oxybutynin was instilled into rat bladders in graded doses by repeated catheterization to study the local bladder effects of drug concentration and incidental urinary infection. On the thirteenth day, after 5 doses, bladders were recovered for measurement and histological study. In the highest dose group, systemic absorption from the bladder caused weight loss and cachexia. However, in no group was there any clear evidence of drug-related mucosal or bladder wall change. Instead, the two high dose groups seemed somehow protected from the combined adverse effects of catheterization and infection.

Administration, Intravesical↗
PubMed1992

The pharmacokinetics of intravesical and oral oxybutynin chloride.

In 8 children with cystometric evidence of bladder instability and marked systemic side effects to oral oxybutynin we investigated the efficacy of intravesical instillation and compared the pharmacokinetics of both routes of delivery. In addition, 4 healthy dogs underwent intravesical instillation for pharmacokinetic studies. Intravesical oxybutynin was well tolerated, efficacious and rapidly absorbed, resulting in plasma concentrations markedly higher than after oral administration. In only 2 patients did this method of instillation result in side effects, and both had previously undergone bladder augmentation. This lack of significant systemic side effects despite high plasma concentrations suggests that a metabolite may be generated after oral administration that is responsible for the side effects. These studies demonstrate that the mode of administration affects the mechanism of action, side effects, pharmacokinetics and metabolism of oxybutynin, and that intravesical instillation is clinically effective and results in minimal side effects.

Administration, Intravesical↗
PubMed1991

The use of intravesical oxybutynin chloride in children with neurogenic bladder.

Intravesical oxybutynin chloride was administered to 10 children with neurogenic bladder (myelomeningocele in 9 and imperforate anus in 1) and urinary incontinence refractory to regimens of intermittent catheterization and oral anticholinergic medication. Therapy consisted of instillation of 5 mg. crushed oxybutynin chloride in 10 cc sterile saline twice daily. Of the children 5 (50%) became completely dry day and night, 3 (30%) achieved daytime continence alone, and 2 did not improve clinically and remained in diapers. Urodynamic study revealed increases in bladder capacity up to 335% over baseline and decreases of maximum filling pressures to 63%. No local or systemic side effects were noted. Surgical bladder augmentation was avoided in those who clinically responded to this therapy.

Administration, Intravesical↗
PubMed1991

The effect of oxyphenonium bromide and oxybutynin hydrochloride on detrusor contractility and reflux in children with vesicoureteral reflux and detrusor instability.

In a prospective study the effects of the anticholinergic drugs oxyphenonium bromide and oxybutynin hydrochloride on detrusor contractility and reflux were studied. Although anticholinergic properties are claimed of both drugs, only oxybutynin hydrochloride proved to decrease detrusor contractility and the degree of reflux, probably due to a direct spasmolytic effect on the detrusor. Therefore, in cases of reflux and detrusor instability treatment with oxybutynin hydrochloride is recommended.

Child↗
PubMed1991

Randomized, double-blind, multicenter trial on treatment of frequency, urgency and incontinence related to detrusor hyperactivity: oxybutynin versus propantheline versus placebo.

Clinical efficacy and adverse effects of oxybutynin and propantheline in the treatment of symptoms related to detrusor hyperactivity were studied in a randomized, controlled, double-blind multicenter trial. Of 169 patients entered into the study 154 were evaluable for statistical analysis. Mean grade of improvement (visual analogue scale) was significantly higher with oxybutynin (58.2%) versus propantheline (44.7%) and placebo (43.4%). Mean bladder volume at first involuntary cystometric contraction was significantly increased with oxybutynin (+57.0 ml.) versus placebo (-9.7 ml.). Mean maximum cystometric bladder capacity was also significantly increased with oxybutynin (+80.1 ml.) versus placebo (+22.5 ml.). Rate of inquired possible adverse effects was significantly higher for oxybutynin (63%) versus propantheline (44%) and placebo (33%). However, only 5 patients dropped out of the study because of adverse effects (oxybutynin 2 and propantheline 3). No serious or lasting adverse effects were encountered with dryness of the mouth being the major complaint. Oxybutynin has statistically significant effects on subjective symptoms and objective urodynamic parameters in patients with detrusor hyperactivity compared to propantheline.

Adolescent↗
PubMed1989

Topical oxybutynin chloride for relaxation of dysfunctional bladders.

Eleven patients with persistent urge incontinence and frequent side effects on oral anticholinergic agents were treated with oxybutynin chloride administered intravesically. Five mg. tablets were dissolved in saline, and the solution was instilled twice daily and retained for 30 minutes. One patient was unable to retain the medication because of severe detrusor hyperreflexia and was eliminated from the study. The remaining 10 patients all reported subjective improvement following treatment and all became totally continent. No side effects were observed. In these 10 patients mean bladder capacity increased from 224 to 360 ml. (p less than 0.01) and mean maximum filling pressure decreased from 33 to 24 cm. water (p equals 0.17). Two additional patients with continent ileocecal urinary diversions were treated with topical oxybutynin chloride instilled directly into the intestinal reservoir. Both patients reported improved comfort with filling and 1 demonstrated a decrease in uninhibited contractions. These encouraging results suggest that treatment with topical oxybutynin chloride is an effective alternative in patients with voiding dysfunction who either are unresponsive to or have intolerable side effects on oral medications.

Administration, Intravesical↗
PubMed1989

In vitro intravesical instillation of anticholinergic, antispasmodic and calcium blocking agents (rabbit whole bladder model).

The systemic side effects accompanying oral pharmacotherapy of neurogenic bladder dysfunction present significant drawbacks to this type of therapy. In these studies we investigated the effect of intravesical administration of anticholinergic, antispasmodic and calcium blocking agents on pressure response mediated by field stimulation and bethanechol. We used the rabbit in vitro whole bladder model for these experiments. The bladder from a mature male NZW rabbit was mounted in an organ bath as a whole bladder preparation. After control field stimulation and bethanechol stimulation, 20 ml. of saline containing the specific drug being evaluated was instilled into the bladder. At 30 minute intervals, the responses to field stimulation and bethanechol were determined. Two hours after instillation of 100 microM of each specific drug, the inhibition of the contractile response to bethanechol and field stimulation (as % inhibition) was as follows: oxybutynin (95%/64%), verapamil (85%/81%), atropine (68%/31%), diltiazem (47%/39%), and imipramine (44%/47%). Atropine and oxybutynin suppressed the contractile response of the bladder to bethanechol to a much greater extent than that to field stimulation, while verapamil, diltiazem and imipramine suppressed the contractile response to bethanechol and field stimulation to approximately the same extent. Two hours after drug instillation, the intravesical solution was washed out and replaced with saline, but the recovery of the bladder contraction was slow and incomplete. The results of this study suggest that the use of self-intravesical instillation to suppress bladder contractility should be a good therapeutic approach for patients with neurogenic bladder, especially those who are already managed by intermittent catheterization.

Administration, Intravesical↗
PubMed1988

Pharmacokinetics and clinical effects of oxybutynin in geriatric patients.

The pharmacokinetics and clinical effects of oxybutynin were examined among 21 elderly (mean age 84 years) patients with urge incontinence and detrusor instability or hyperreflexia. The drug did not accumulate to high levels after a week of treatment at dosages of either 2.5 or 5 mg. 3 times per day, and the mean peak level on 5 mg. among the elderly (12.5 ng. per ml.) was not statistically different than the mean peak level reported after the same dosage in young healthy men (8.9 ng. per ml., p equals 0.4). There were no clinically meaningful changes in heart rate, blood pressure or intraocular pressure during the treatment periods. Two-thirds of the patients suffered at least 1 side effect, most commonly dryness of the mouth that was not severe enough to warrant discontinuation of the drug. These data suggest that oxybutynin chloride at dosages of 2.5 to 5 mg. 3 times per day is safe for use in the elderly, even among octogenarians. Statements about its effectiveness and efficacy in the geriatric population must await controlled clinical trials.

Aged↗
PubMed1987

Comparison of calcium antagonist properties of antispasmotic agents.

Several agents commonly employed for the treatment of detrusor hyperreflexia or instability are characterized as antispasmotics. Their mechanism of action is not completely understood but it has been proposed that their actions are dependent on anticholinergic activity, CNS mediated relaxation, or local anesthetic properties. The purpose of this study was to determine if imipramine, flavoxate HCl, or oxybutynin HCl possess any calcium antagonist properties. This was accomplished by determining the ability of these agents to inhibit a standard cholinergic stimulus (200 uM bethanechol) over a range of extracellular calcium concentrations (0.5 to 10.0 mM). In-vitro isolated smooth muscle strips of rabbit bladder dome were utilized. Control tissues displayed a reproducible response to bethanechol stimulation at different calcium concentrations with an ED50 of 0.4 mM calcium and a peak response of 5.0+/-0.4 grams tension. Flavoxate (2.5 mM), oxybutynin (2.5 uM), and imipramine 25 uM) all significantly reduced peak tension generation. The ED 50's for extracellular calcium in the presence of flavoxate and oxybutynin were not significantly different from controls. Imipramine at both 3 and 25 uM significantly increased the ED50 for calcium. The above data demonstrate that imipramine possesses competitive calcium antagonism. The relative contribution of calcium antagonism toward the inhibitory effects of imipramine is unknown but may play a significant role in its clinical activity.

Animals↗
PubMed1986

Oxybutynin versus propantheline in patients with multiple sclerosis and detrusor hyperreflexia.

Hyperreflexia is the most common urological finding in patients with multiple sclerosis. A prospective randomized study was done to compare the effectiveness of 2 commonly used drugs, oxybutynin and propantheline. Of the 34 patients entered into the trial 19 were treated with oxybutynin and 15 with propantheline. The urological symptoms (frequency, nocturia, hesitancy, urgency and urge incontinence) were graded according to severity from 0 to 3. Patients with urinary infection were excluded. Urodynamic examination, consisting of cystometrography and electromyography, was performed in all patients before treatment. Both groups of patients had comparable neurological, urological and urodynamic status before treatment. In 4 patients (21 per cent) treated with oxybutynin and in 4 (27 per cent) treated with propantheline side effects were so severe that the treatment had to be discontinued. Symptomatic response to oxybutynin was good in 10 patients (67 per cent), fair in 2 (13 per cent) and poor in 3 (20 per cent). Propantheline produced good symptomatic results in 4 patients (36 per cent), fair in 1 (9 per cent) and poor in 6 (55 per cent). The mean increase in maximum cystometric capacity on cystometrography was significantly larger in the oxybutynin group than in the propantheline group (144 +/- 115 versus 35 +/- 101). Our results indicate that oxybutynin is more effective than propantheline in the treatment of detrusor hyperreflexia in patients with multiple sclerosis.

Female↗
PubMed1985

Effects of oxybutynin on vesicoureteral reflux in children.

We reviewed retrospectively 40 children seen from 1980 to 1984 with vesicoureteral reflux in 53 ureters. All patients had a hyperreflexic bladder on urodynamic evaluation with or without vesicoperineal dyssynergia but they were otherwise neurologically normal. All except 1 child received prophylactic antibiotics. Of the children 37 received oxybutynin therapy for bladder hyperreflexia for 3 to 18 months. Reflux disappeared or became grade I in 62.3 per cent of the ureters. Of the children manifesting urinary incontinence at the time of urodynamic study reflux disappeared or became grade I in 78.6 per cent. Reflux resolved or became grade I in 20 per cent of the children with no urinary incontinence. Of those patients with recurrent reflux at the onset of urinary incontinence and bladder instability reflux resolved or became grade I in 80 per cent. Oxybutynin therapy for hyperreflexic bladder resulted in an average increase in bladder capacity of 97 cc (54.2 per cent), which was maintained after cessation of treatment. These data suggest that bladder instability can be an important factor in causing and perpetuating reflux. Therapy aimed at decreasing intravesical pressure will enhance resolution or downgrading of reflux.

Child↗
PubMed1985

Radioisotope renography in spinal cord injury.

Isotope renography was compared to excretory urography, voiding cystourethrography and endogenous creatinine clearances in 52 spinal cord injury patients. Renogram abnormalities were detected in 86 per cent of the cases. The most common abnormality was the delay of isotope excretion from the renal cortex and pelvis. Anticholinergic medication significantly reduced these excretion delays. A subgroup containing 22 newly injured patients was evaluated separately. Renogram abnormalities in this subgroup were associated with normal excretory urography and normal creatinine clearances. We postulate that the defect producing upper tract deterioration in spinal cord injury begins early, is obstructive to renal drainage, does not increase with time and probably requires early intervention with anticholinergic medication or transurethral sphincterotomy to prevent upper tract damage.

Adult↗
PubMed1984

Intermittent catheterization: evaluation of complete dryness and independence in children with myelomeningocele.

We studied 46 children in active followup who have been managed by nonsterile intermittent catheterization to achieve continence. All patients were given maximum therapeutic doses of supplemental medication to improve dryness. Of the patients 33 per cent were noncompliant and, therefore, wet, 30 per cent were wet despite full compliance with the program, and only 24 per cent were completely dry and wearing regular underclothing. Nine children experienced side effects from the supplemental medications that were severe enough to warrant discontinuation of the drug. Of the 46 patients 19 have been removed from the catheterization program and currently are being managed by other modalities. Only 11 of the remaining 27 patients currently managed by catheterization perform the procedure independently. Results suggest that intermittent catheterization does not provide independence or social continence in many patients.

Adolescent↗
PubMed1984

Prevention of urinary tract infection during intermittent catheterization.

We studied prospectively 40 patients with recent spinal cord injuries to determine the effectiveness of the combination of oral methenamine and an intravesicular acidifying agent for prevention of urinary tract infection during intermittent catheterization. The incidences of bacteriuria and symptomatic urinary tract infections were significantly less in the treated group. This combination appears to be a safe, effective means to reduce pyelonephritis in spinal cord injury patients on intermittent catheterization.

Bacteriuria↗
PubMed1983

The uninhibited bladder in children: effect of treatment on recurrence of urinary infection and on vesicoureteral reflux resolution.

We studied and treated prospectively 62 neurologically normal children with vesicoureteral reflux using urodynamic techniques to identify uninhibited bladder contractions with voluntary sphincteric obstruction (dyssynergia). All children received antibiotic prophylaxis. Anticholinergic drugs were used additionally to treat uninhibited bladder contractions. During 6 years of followup treatment of uninhibited contractions produced a 4-fold reduction in the incidence of recurrent urinary infection and tripled the rate of reflux resolution compared to controls. These data suggest that uninhibited contractions with voluntary sphincter obstruction are an important prognostic finding in children with reflux, which when treated successfully can alter the disease course and may make surgical therapy of reflux unnecessary for some.

Adolescent↗
PubMed1982

Direct measurement of the anticholinergic activity of a series of pharmacological compounds on the canine and rabbit urinary bladder.

Antimuscarinic therapy is used widely in the treatment of urine storage failure. Examples of antimuscarinic agents used clinically include atropine, propantheline bromide and glycopyrrolate. Other agents used in clinical urology that are believed to act at least in part by antimuscarinic activity include oxybutynin, imipramine and dicyclomine, These studies were designed to determine the relative potency of a variety of agents to compete directly for muscarinic cholinergic receptors isolated from the canine and rabbit urinary bladder. Radio-ligand binding assays for muscarinic receptors were performed with 10 nM 3H-QNB and various concentrations of the drugs under study. Of the agents tested, propantheline bromide, atropine, and glycopyrrolate were the potent muscarinic antagonists/unit of concentration. Oxybutynin and dicyclomine hydrochloride were 30 to 50 times less potent than atropine. Chlorpromazine and desmethylimipramine were approximately 500 times less potent than atropine. As expected, agents such as guanethidine, tranylcypramine and hexamethonium possessed little antimuscarinic activity.

Animals↗