Developing a research program for intravesical oxybutynin in children with poorly compliant neurogenic bladders

Abstract

Statement of the problem. Children with neurogenic bladders and poor bladder compliance are usually managed with bladder catheterization and oral anticholinergic medication. They may become non-responders to the drug or present with severe harms. Oxybutynin intravesically is an alternative therapy. Methods. CHEO experience (case series) with intravesical oxybutynin. Systematic review of the literature of intravesical oxybutynin in children with neurogenic bladders. Protocol for a RCT is proposed. Results. CHEO case series and the systematic review suggest intravesical oxybutynin is effective and well tolerated. There was a significant improvement in urinary incontinence and urodynamic outcomes. Published studies are of low level of evidence, and there was no RCT. The incidence of harm was low. Conclusion. Based on the evidence collected, there is not sufficient justification to recommend this therapy for children with neurogenic bladder. Research with a more sound study design, such as RCT, should be conducted to assess the efficacy of this intervention in children.