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Intravesical atropine suppression of detrusor hyperreflexia in multiple sclerosis
  1. CARL DEANEY
  1. Academic Department of Surgery, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  2. Department of Medical Rehabilitation, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  3. Medicine for the Elderly, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK
  1. Professor James G Malone-Lee, Department of Geriatric Medicine, University College London Medical School, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.
  1. SCOTT GLICKMAN
  1. Academic Department of Surgery, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  2. Department of Medical Rehabilitation, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  3. Medicine for the Elderly, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK
  1. Professor James G Malone-Lee, Department of Geriatric Medicine, University College London Medical School, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.
  1. TIMOTHY GLUCK
  1. Academic Department of Surgery, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  2. Department of Medical Rehabilitation, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  3. Medicine for the Elderly, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK
  1. Professor James G Malone-Lee, Department of Geriatric Medicine, University College London Medical School, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.
  1. JAMES G MALONE-LEE
  1. Academic Department of Surgery, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  2. Department of Medical Rehabilitation, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
  3. Medicine for the Elderly, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK
  1. Professor James G Malone-Lee, Department of Geriatric Medicine, University College London Medical School, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.

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Multiple sclerosis commonly causes urinary frequency, urgency, and urge incontinence resulting from detrusor hyperreflexia. This might be associated with voiding difficulties due to detrusor sphincter dyssynergia. These symptoms can be treated effectively with antimuscarinic drugs (principally oxybutynin) and clean intermittent catheterisation, but the antimuscarinic side effects limit clinical usefulness. Typically these are dry mouth and blurred vision, but include constipation, reflux oesophagitis, and flushing.

Oxybutynin, formulated for intravesical administration, has been reported to be effective for suppressing detrusor hyperreflexia with low incidence of side effects in various neuropathic disorders.1 2 However, this preparation is not widely available.

Atropine is a cheaper, easily obtainable, antimuscarinic drug. Administered intravesically it has been shown to be effective in increasing bladder capacities without side effects in patients with spinal cord injury.3 However, the only study was small and uncontrolled. Whereas the pathologies of multiple sclerosis and spinal cord injury are different, the bladder impairments are similar. This study …

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