The Effect of an Anticholinergic Agent(Oxybutynin) on Spontaneous Resolution of Primary Vesicoureteral Reflux

Ahn, So-Hyun; Shim, So-Yun; Lee, Jung-Won; Cho, Su-Jin; Lee, Seung-Joo

J Korean Soc Pediatr Nephrol > Volume 7(2); 2003 > Article

J Korean Soc Pediatr Nephrol 2003;7(2): 174-180.

항콜린제(옥시부티닌)가 원발성 방광요관역류의 자연 소실에 미치는 영향

안소현, 심소연, 이정원, 조수진, 이승주

¹이화여자대학교 의과대학 소아과학교실
²이화여자대학교 의과대학 소아과학교실
³이화여자대학교 의과대학 소아과학교실
⁴이화여자대학교 의과대학 소아과학교실
⁵이화여자대학교 의과대학 소아과학교실

The Effect of an Anticholinergic Agent(Oxybutynin) on Spontaneous Resolution of Primary Vesicoureteral Reflux

So-Hyun Ahn, So-Yun Shim, Jung-Won Lee, Su-Jin Cho, Seung-Joo Lee

¹Department of Pediatrics, Ewha Womans University College of Medicine
²Department of Pediatrics, Ewha Womans University College of Medicine
³Department of Pediatrics, Ewha Womans University College of Medicine
⁴Department of Pediatrics, Ewha Womans University College of Medicine
⁵Department of Pediatrics, Ewha Womans University College of Medicine

ABSTRACT

Purpose : Unstable bladder has been known to be one of the reasons for the genesis and persistance of primary vesicoureteral reflux(VUR) in children. And treatment of unstable bladder by anticholinergic agent may contribute to the resolution of primary VUR. We evaluated the effect of an anticholinergic agent(oxybutynin) on the resolution of primary VUR in children with different toilet training and voiding functions.
Methods : 152 children with persistant primary VUR after one year of follow up were randomly assigned to the oxybutynin group(n=59, oxybutynin 0.2 mg/kg twice daily) and the control group(n=93, no oxybutynin) at Ewha Womans University Mok-Dong Hospital from October 1996 to April 2002. The resolution rate of the VUR and the difference according to the status of toilet training and voiding dysfunction were analyzed. Statistical analysis was done by the Chi-square test and a P-value of less than 0.05 was considered as significant.
Results : VUR was resolved in 49.2%, improved in 20.3% and not changed in 30.5% in the oxybutynin group(n=59) which was not significantly different to 45.2%, 16.1%, 38.7% in the control group(n=93), respectively. In the non-toilet trained young children, VUR was resolved in 50.0%, improved in 23.5% and not changed in 26.5% in the oxybutynin group(n=34) which was not significantly different to 44.2%, 19.2%, 36.6% in the control group(n=52), respectively. In the toilet trained older children, VUR was resolved in 48.0%, improved in 16.0% and not changed in 36.0% in the oxybutynin group(n=25) which was not significantly different to 46.3%, 12.2%, 41.5% in the control group(n=41), respectively. In the toilet trained older children with no voiding dysfunction, VUR was resolved in 33.3%, improved in 11.1% and not changed in 55.5% in the of oxybutynin group(n=9) which was not significantly different to 53.6 %, 10.7%, 35.7% in the control group(n=28), respectively. In the toilet trained older children with voiding dysfunction, VUR was resolved in 56.3%, improved in 18.7% and not changed in 25.0% in the oxybutynin group(n=16), which looked higher than 30.7%, 15.4%, 53.9% in the control group(n=13), respectively, but these were not significantly different either.
Conclusion : Oxybutynin was not effective in the resolution of primary VUR in non-toilet trained young children and toilet trained older children. Oxybutynin showed slightly higher tendency of reflux resolution in toilet-trained older children with voiding dysfunction but the difference was not statistically significant. Judicious use of oxybutynin is required in selected older children with VUR and voiding dysfunction.

Key words: Vesicoureteral reflux | Oxybutynin | Unstable bladder