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Catheter-related bladder discomfort (CRBD) is an unrecognized clinical event. Symptoms of CRBD secondary to an indwelling urinary catheter mimic those of an overactive bladder, i.e. urinary frequency and urgency with or without urge incontinence. Stimulation of muscarinic receptors located in the bladder wall by the catheter is the triggering factor. Postoperative pain may be increased by the CRBD. Antimuscarinic drugs, as oxybutynin, are today the main treatment. Further studies are warranted to confirm efficacy of ketamine, tramadol and gabapentin in this situation.

Hyperhidrosis is a functional disorder characterized by increased sweating that can greatly impair quality of life due to psychosocial factors. It is most often localized (underarms, hands, feet) but can also be generalized. In this case, after eliminating an underlying cause, systemic treatment may be proposed. In this retrospective study, we report the benefits and adverse effects of the anticholinergic drug oxybutynin.All patients treated with oxybutynin between February 2008 and October 2010 for troublesome generalized hyperhidrosis were recruited after ruling out underlying disease. Oxybutynin (Ditropan(®)) was started at a dose of 1.25mg then increased in increments of 1.25mg every 4 days up to the lowest effective dose, which did not exceed 2.5mg three times per day in order to avoid serious adverse effects. After 2 months of treatment, patients were asked to rate their satisfaction on a scale of 0 to 10, as well as degree of efficacy, time to efficacy, type of adverse effects and whether or not treatment was continued.Thirty patients were included in this study: 24 women and 6 men aged 19 to 64 years (mean=33 years). The treatment was rated by 24 patients (80%) as very effective and by three patients (10%) as moderately effective. Three patients (10%) stopped the treatment due to adverse effects such as faintness and ocular accommodation disorders, and for these patients, the degree of satisfaction ranged from 1 to 3/10. For the other 27 patients, satisfaction was 6 to 10 with a median of 8.5. The onset of action was between 10 and 21 days with an average of 15.4 days. Adverse effects were present in 10 of 27 patients (37%) comprising dry mouth, which was well tolerated (grade 1). Mean follow-up was 14.9 months (2 months to 32 months), with two patients being lost to follow-up.The treatment of primary extended or generalized hyperhidrosis is not currently codified. Our study shows the efficacy of oxybutynin in this indication at a moderate dose, with good safety. The satisfaction index was high, with 80% of patients considering the drug very effective and for 10% considering it moderately effective. To our knowledge, this is the first retrospective study in a large population. A placebo-controlled study could provide the grounds for a therapeutic consensus concerning a drug widely known for many years in the treatment of extensive hyperhidrosis.

Total prostatectomy (TP) is one of the referential treatments of localized cancer of the prostate gland. Urethrovesical anastomosis and urinary catheterization may be sources of strong contractions of the detrusor muscle responsible for intense pain which is added to parietal pain. This study evaluates the efficiency of oxybutynin in the treatment of this postoperative pain (POP).Forty-five patients due to benefit from a TP by laparotomy were included in this prospective study. A urinary catheter was put in place during the operation. Patients were randomly split into two groups in the postoperative care room. Group P (n = 23) received a placebo in tablet form and group O (n = 22) received 5mg of oxybutynin in sublingual form. The POP was evaluated every 2 hours using the Visual Analogue pain Scale (VAS 0:10).The accumulated dose of tramadol after 8 hours was 110.8 mg in group P and 39.7 mg in group O (p0.05). For group P, 15/23 of the patients (65%) were in pain versus 4/22 (18%) in group O. The VAS scores of group P were higher (4.1 +/- 1) than those of group O (1.2 +/- 0.9). For group P, when the PCA dose of tramadol was inefficient, a tablet of oxybutynin 5 mg brought the VAS scores down to the same level of those of group O within 2 hours. No side effects linked to the antimuscarinic action were observed.Oxybutynin given in sublingual form reduced, at postoperative stage, the frequency and intensity of pain linked to the bladder wound and to the catheter after TP. Its use for the POP of the bladder section reduced the consumption of postoperative analgesia.

Intravesical oxybutynin chloride has demonstrated its efficacy in children with neurogenic bladder and urinary incontinence refractory to oral anticholinergic agents. We developed a 205 microg/ml oxybutynin chloride solution in accordance with the specifications of the European Pharmacopeae. To guarantee quality, we assessed and validated formulation, the preparation process, and packaging. The solution was obtained by disolving oxybutynin chloride in 0.9% saline and sterile filtration. The solution was then packaged in syringes. Physical properies for intravesical instillation were met: pH 5.76 +/- 0.03, osmolality 281 mosmol/kg. The unit dose package guarantees sterility of the solution until use. The medication is given by adapting the syringe on the Luer Lock exteremity of the urinary catheter. The solution remains stable up to one month at 4 degrees C.

Overactive bladder, very frequent in neurological disorders, leads to very distressing symptoms such as urgency, frequency and incontinence which may dramatically impair the patient's quality of life. The medical approach is essentially pharmacological but the management of the nociceptive factors must not be neglected. In the mild urinary dysfunctions, bladder training can be advised. The pharmacological treatment aims at reducing the parasympathetic activity or at deafferenting the bladder. The antimuscarinic agents are an essential part of the treatment. Oxybutynin is the most widely used medication but recent agents like tolterodin have a better tolerability. Other drugs can also be used such as desmopressin, flavoxate. New molecules are under experiment (darifenacin). In case of troublesome side-effects or resistance to oral medications, local treatments are considered. Intravesical oxybutynin has been tried but has a short-lived efficacy. Intravesical instillation of capsaicine or resiniferatoxin blocks C-fibres afferents and leads to clinical and urodynamic improvement. Recently, injections of botulinum-A toxin in the detrusor have been advocated aiming at blocking the transmission of parasympathetic impulse. The first studies report encouraging results. All these local treatments resulting in bladder paresis are recommended for patients performing self-catheterization. Should these treatments fail, other therapeutic approaches are considered such as intrathecal treatment, neuromodulation, before deciding on neurosurgical or urosurgical procedures.

Assess improvement in quality of life using a validated scale in women with urge incontinence or pollakiuria treated with oxybutynine.A prospective open multicentric trial was conducted in 1701 women aged 20 to 60 years (mean 47.6) with the last 2 months. Quality of life was assessed on the Ditrovie scale before and after a 3-month treatment with oxybutynin (7.5 to 15 mg/day).Patient compliance was good (97%) and side effects rare (8%) (mainly dry mouth). There was a significant symptom improvement (por = 0.0001) between day 0 and day 90 after treatment: 48% of the women no longer had incontinence with a safety interval of more than 15 minutes compared with 0.2% prior to treatment; urge incontinence disappeared in 75% of the 81% affected women; 82% of the women had an intermictional interval longer than 2 hours after treatment compared with 33% prior to treatment. There was a significant improvement in the quality of life scores after treatment (p0.0001), as assessed by the overall score and subscores (daily life, emotional impact, self-image, sleep, well-being).These findings demonstrate the efficacy of oxybutynine in improving urge incontinence and pollakiuria in women, both in terms of symptom relief and quality of life.

Emotional instability which might be an early symptom of more severe disorders, is one of the first manifestations of chronic exposure to organic solvents. The present study measures the association between exposure to styrene and mood states of active workers. A total of 128 workers (85% of the total population) from 3 factories where styrene is used, participated on a voluntary basis. They filled out the following self-administered questionnaires: Profile of Mood States (POMS), Psychiatric Symptom Index and Well-being Index. The results indicate a significant relationship between post work-shift urinary mandelic acid (biological indicator of styrene exposure) and the scores obtained on the POMS scales of tension-anxiety (Spearman's rank correlation rho = 0.30; p0.01), anger-hostility (rho = 0.29; p0.01), fatigue-inertie (rho = 0.34; p0.01), and confusion-bewilderment (rho = 0.23; p = 0.04), as well as the Psychological Distress Index (rho = 0.30; p0.01). All scores were adjusted for the effects of 4 potentially confounding variables: age, schooling, alcohol and cigarette consumption. These indicators of mood states do not constitute a diagnosis of mental disease but reveal progressive deterioration of well being associated with neurotoxic exposure in the workplace.

Bedwetting is present in 5 to 7% of children aged 7 to 8 years. The history of the disorder and the examination of the child are of main importance. This is usually the first step to identify nocturnal enuresis, bladder or urethral instability and other voiding dysfunctions. Therapeutic failure is often related to an inadequate analysis of the disorder. For nocturnal enuresis, the best results are obtained with alarms and/or desmopressine; bladder instability usually requires oxybutinine chlorydrate and urethral instability can be treated with biofeedback therapy. The management of other voiding dysfunctions depends on urodynamic assessment.

The side effects of oxybutynin chloride (Ditropan) often include atropinic and allergic reactions. Their relative frequency in children merits a nationwide investigation.All the side effects of Ditropan reported to the French Regional ADR monitoring centers and to the pharmaceutical firm Debat between January 1985 and June 1990 were analysed. Only 87 effects of the 286 side effects reported in adults and children occurred with sufficient frequency in 84 children to warrant study.The 84 children (38 males, 43 females, 3 of unknown sex) were 30 months to 15 years old (mean: 6.5 years); 13 of them were less than 5 years. The mean dose of Ditropan prescribed was 0.5 +/- 0.12 mg/kg/day. 52 children developed atropinic symptoms, 20 skin and/or allergic reactions and 15 various other manifestations. These side effects required admission to hospital in 14% of cases. The side effects were 4 times more frequent in children (1/4,000 regulations) than in adults.The higher frequency of atropinic reactions in children may be due to the higher dosage of the drug used and/or to differences in hydroxylation metabolism, that is genetically determined in adults. New recommendations for use of this drug are proposed.

We analyzed the 200 reported cases of adverse reactions to Ditropan (209 side-effects) collated by the Centres Régionaux de Pharmacovigilance and Laboratoire Debat since the drug was first marketed. The frequency of such side-effects was of the order of 1 per 20,917 treatment months. Children were affected four times more frequently than adults. The manifestations resembled atropine overdose in 103 cases (52 children, 51 adults), and were mainly neurological (59%) and ocular (22%). Two cases of erythema multiform and 33 of miscellaneous allergic skin reactions occurred. The fact that atropine overdose was more frequent in children can be explained by the proportionately higher dosage. Dose adjustment based on pediatric pharmacokinetic studies appears to be essential. In children, the drug is prescribed most frequently (56%) for conditions outside the licensed indications, particularly nocturnal enuresis, a condition for which the efficacy of Ditropan has not been established. We consider that this calls for a specific contraindication in isolated nocturnal enuresis and in children aged less than five years.

15 patients with neurogenic detrusor hyperactivity refractory to oral anticholinergics received a daily intravesical instillation of 5 mg of oxybutinin for 6 days. An improvement was observed clinically in 10 cases and on urodynamic parameters (60% increase in bladder capacity, doubling of the volume inducing an urge to void) in 12 cases. The mechanism of action is discussed.

We report a case of behavior disorders due to ingestion of two closely spaced oral doses of chloride of oxybutynin in a six-year-old. This drug is not indicated in isolated enuresia. More rigid dosage schedules with longer time intervals between doses are needed.