The Long-Term, Real-World Effects of Oxybutynin on Pressure Reservoir Function in the Neurogenic Bladder after Spinal Cord Injury: A Retrospective Cohort Study

J. Clin. Med., 2024 · DOI: 10.3390/jcm13154514 · Published: August 2, 2024

Simple Explanation

This study looks at how well a drug called oxybutynin works over a long time for people with bladder problems caused by spinal cord injuries. Oxybutynin helps control bladder pressure. The researchers checked medical records to see how bladder pressure and capacity changed in patients taking different doses of oxybutynin, sometimes combined with another drug called trospium. The study found that higher doses of oxybutynin, especially when combined with trospium, helped to lower bladder pressure over the long term in these patients.

Study Duration

2.8 years

Participants

107 patients with neurogenic bladder due to spinal cord injury

Evidence Level

Not specified

Key Findings

1
High-dose oxybutynin (20–40 mg/day) significantly reduced maximal detrusor pressure (MDP) over three follow-up visits.
2
The combination of oxybutynin and trospium also resulted in a significant long-term reduction in MDP.
3
Low-dose oxybutynin (5–15 mg/day) showed a significant decrease in MDP only at the first follow-up, with effects waning over time.

Research Summary

This retrospective cohort study evaluated the long-term effects of oxybutynin and oxybutynin combined with trospium on maximal detrusor pressure (MDP) and cystometric bladder capacity (CBC) in patients with neurogenic bladder (NGB) after spinal cord injury (SCI). The study found that high-dose oxybutynin and the oxybutynin–trospium combination achieved a significant long-term reduction in MDP, sustained across three follow-up periods. Low-dose oxybutynin showed an initial reduction in MDP, but the effect waned over time; CBC remained remarkably stable across all treatment groups with no significant changes observed.

Practical Implications

Treatment Strategies

High-dose oxybutynin or a combination of oxybutynin and trospium may be more effective for long-term management of neurogenic bladder in SCI patients compared to low-dose oxybutynin.

Clinical Monitoring

Regular monitoring of bladder function is crucial, as the effectiveness of low-dose oxybutynin may decrease over time, necessitating dosage adjustments or alternative treatment strategies.

Personalized Medicine

Treatment decisions should consider the severity of the condition (baseline MDP), lesion level, completeness of the lesion, bladder management methods, and predicted risk of upper tract deterioration to optimize patient outcomes.

Study Limitations

1
Retrospective design with inherent limitations.
2
Unavailable medication adherence data.
3
Attrition rate of approximately 14.9–17.6% due to loss to follow-up, potentially introducing selection bias.

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