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.