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Early use of Bladder Relaxant (Oxybutynin) in Posterior Urethral Valve Patients. Is it Justified?

Sajad Ahmad Wani, Narindra Babu, Mir Faheem, Viney Jadhav, Ramesh S, Deepak J

Introduction: Posterior Urethral Valves (PUV) constitute the most common infravesical urinary obstruction in boys. Bladder dysfunction, the pattern of which changes with the age and is common cause of morbidity in PUV patients. Urodynamic study provides a useful tool to identify the bladder dysfunction and allow timely and appropriate management. The aim of this study was to determine the efficacy of early use of bladder relaxant (oxybutynin) on urodynamic parameters in PUV patients and to compare our results with other authors.

Material and Methods: Patients with posterior urethral valves more than 4 years of age were included in the study. After the diagnosis, oxybutynin was started prophylactically in all patients. Invasive urodynamic study was done in all patients minimum one year after start of oxybutynin. Bladder relaxant (oxybutynin) was stopped 48 hours before the study. Various urodynamic parameters which were noted in each patient include compliance, bladder stability (normal/overactivity), bladder capacity, detrusor pressure during voiding (sustained, waxing and waning or myogenic failure), detrusor sphincter dysynergia and post void residue.

Results: 47 patients were included in the study. Age of patients ranged from 4 years to 14.8 years with mean age of 8.4 years. Normal detrusor pressure during filling (stable bladder) was seen in 95.7% of patients, bladder overactivity in 4.3% of patients, compliance (compliance good in 89.4% and compliance poor in 6.4%), bladder capacity (normal (70.2%), decreased (10.6%) and increased (19.1%), detrusor pressure during voiding (sustained (68.1%), waxing and waning (21.3%) and myogenic failure (10.6%)).

Conclusion: Early use of oxybutynin immediately after the diagnosis of PUV, improves the urodynamic parameters in these patients possibly because of protective effect of oxybutynin on bladder function and structure.