This report deals with the control of detrusor
hyperreflexia by the
intravesical instillation of
oxybutynin hydrochloride (
OH) in 10 male and 3 female patients with complete suprasacral spinal cord lesions having clean intermittent catheterisation (CIC) because of unbalanced voiding. The indication for intravesical
OH application was persisting
urinary incontinence despite CIC in 11 patients and in 2 patients detrusor hypercontractility. One 5 mg
tablet of
OH was dissolved in distilled water and the
solution was instilled into the bladder through the
catheter, which has been used for urodynamics and which was then removed. Six hours later cystometry was repeated and the clinical effects were studied especially with regard to continence/incontinence and side-effects. The differences in the cystometric bladder capacity and maximum detrusor pressure before and after instillation of
OH are statistically highly significant. Clinically, from those 10 patients who were incontinent between CIC before, 9 remained dry during the 6-hour period. None of the patients reported any side-effect after intravesical application of
OH. However, with subsequent oral medication 8 out of 12 patients complained of typical
anticholinergic side-effects. These results indicate that treatment with topical
OH is an effective alternative to treating detrusor
hyperreflexia, especially in patients already on CIC because of unbalanced voiding, but with persisting
urinary incontinence due to detrusor
hyperreflexia.
OH is well absorbed from the bladder, however absorption seems to be protracted compared to oral intake.