? about intravesicular detrusitol (detrol)

Bke · 11-07-2003, 02:26 PM

I've read about it and I'm going to try it. Oxybutinine (ditropan) didn't do a thing for me. Then 2 weeks ago I've started taking 2x2mg of detrusitol and my volumes went from 200ml up to 350 average (but once even 500ml). But the side effects are very 'annoying'. Dry mouth, eyes, ...and terrible constipation. So now I'm going to try to take it intravesicular. I've read about dissolving the tablet into 30ml of sterile water. It's a difficult procedure for me with one functional hand and so 10ml would be much easier. Would this also do? (2mg/10cc)And how long can you work with the same syringe? Also I'm a bit afraid of getting UTI's using this procedure, is there a high risk? And one last question, most of the time when I have a UTI and I test my urine with multistix, the nitrites colour up. Is this a certain type of UTI that can be avoided? Thanks for the advice!
Bke

SCI-Nurse · 11-07-2003, 03:06 PM

I know KLD has talked about intravesicular administration of ditropan but not detrol. You can check out this previous post for some answers that may apply to your question.

http://carecure.org/forum/showpost.php?p=11233

I work mainly in the inpatient setting and don't have any experience with such an instillation. Has your urologist suggested this to you? Of course you need to do all instillations under their direction and advice. PLG

Bke · 11-07-2003, 11:59 PM

Thanks nurse, I've read all the posts on the forum about detrol/ditropan/intravesicular/augmentation/... but no answer to my questions.
I went to my urologist about 2 weeks ago; he prescribed me the detrusitol but said it probably wouldn't do a thing for me. He made me another appointment next friday to discuss the effects and probably talk about an augmentation. So before I go back to talk about an augmentation I want to be sure there's no other options. Since the side effects of the oral intake are too 'annoying', I now wanted to try the intravesicular way for the other week. Just one week and then on friday discuss the 'hopefully positive' results with my urologist.

stephen212 · 11-08-2003, 02:31 PM

Bke74,

If you've read all the threads on intravesicular Ditropan on this site then you know I'm evangelical about this procedure. I'll try my best to answer some of your questions.

I have no experience using Detrol intravesicularly. For starters, it's expensive; and unlike Ditropan, Detrol is not yet available in the US as a generic. Also, according to my urologist Detrol has never been proven to be more effective than Ditropan. Its selling point is that presumably its side effects are less intense -- for some people. Chemically, however, my understanding is that the two drugs are more similar than not. So, if you're going to begin instilling meds into your bladder, I would go with Ditropan (oxybutynin) despite your less than great results taking it orally.

Can you explain why you're able to prepare a 10cc syringe, but not a 30cc syringe? IDo you feel an appreciable difference in weight between the two and thus it's more difficult for you to handle?

I don't use sterile water to prepare my syringes; distilled H20 is inexpensive and readily available and, for all intents and purposes, IS sterile. It's sold in gallon (4 liter) containers, but I decant it into an easy to hold 1/2 liter-size pull-top bottle for easy handling.

As for the amount of water: anything less than 30cc and there's a good chance that it won't be distributed to enough of the bladder wall to be effective. Unless you've got a Munchkin-size bladder, I don't think 10cc is enough.

The type of syringe you use is also important. I use a Bard piston syringe (order no. 38470) because it's extremely easy to grip. Ane while you could probably use one syringe for several days, I use a new one every day because I can -- my insurance covers them.

I don't do anything extraordinay to protect against UTIs: no meds, no supplements, no drinking gallons of H20/day, etc. I've been doing the Ditropan instillation thing for a few years now and, maybe I'm just lucky, but if I've gotten only one minor UTI. I wonder, maybe there's something about the Ditropan solution that actually protects against UTIs.

Unfortunately there's a limit to explaining all of this in writing -- a demonstration is far preferable. Since that's not too likely, you're going to have to discover your way through trial and error.

I was very close to needing an augmentation procedure. Discovering intravesicular ditropan has made the single greatest lifestyle difference in my 20 year post-SCI existence. I hope it works for you.

[This message was edited by Stephen NYC on 11-08-03 at 11:10 PM.]

[This message was edited by Stephen NYC on 11-09-03 at 02:24 PM.]

Wise Young · 11-08-2003, 05:21 PM

thanks, stephen for stepping in. I was hoping that you would. Wise.

SCI-Nurse · 11-09-2003, 10:17 AM

Thanks Wise and Stephen ! PLG

Bke · 11-10-2003, 08:17 AM

Thanks Stephen, I also was hoping you, as the expert, would answer my questions. I've started with the procedure today. My mom is preparing the syringes now (with detrusitol). If/when it works, and there's good results, I'll try to find a method so that I can fill a 30cc syringe myself. I hope the results will be immediate cause I'm going to my urologist this friday and when there's no results, I guess an augmentation is the only option left... Thanks, Bke

crags · 11-10-2003, 08:45 AM

using detrol intravesicular could be a waste of money. you're getting only a limited exposure to the medication as it bathes the bladder wall only for a short time while it gets immediately diluted with new urine and completely removed at the next cath. using a more expensive med may not give you any better result.

i get syringes with a ring end or slip a string loop around the end so i can pull it up. someone can leave the 30 cc in a bottle for you, pop in a pill, wait till dissolved then proceed. i'm c7 and have it down.

Bke · 11-13-2003, 10:53 AM

:-( I've tried taking detrol intravesicularly for 3 1/2 days and I'm back to minimal volumes: 100ml, 200ml max. I'm a bit dissapointed; it was kind of my last hope before augmentation surgery, well second last. Tomorrow I'll ask my urologist about botox. I'm anxious to here my Dr's opinion and experience. Anyway, thanks again for your help Stephen.

[This message was edited by Bke74 on 11-13-03 at 02:19 PM.]

stephen212 · 11-13-2003, 06:17 PM

Bke,
I've never heard of anyone instilling Detrol, so I'm not surprised to learn that it didn't work. It's still not clear to me, however, whether you've ever tried instilling Ditropan (oxybutyin). Isn't it worth a try before moving on to Botox (there's a lifetime limit to the number of botox shots you can get) or augmentation surgery?

11-07-2003, 02:26 PM	#1
Bke Senior Member Join Date: Aug 2003 Location: Belgium Posts: 224	? about intravesicular detrusitol (detrol) I've read about it and I'm going to try it. Oxybutinine (ditropan) didn't do a thing for me. Then 2 weeks ago I've started taking 2x2mg of detrusitol and my volumes went from 200ml up to 350 average (but once even 500ml). But the side effects are very 'annoying'. Dry mouth, eyes, ...and terrible constipation. So now I'm going to try to take it intravesicular. I've read about dissolving the tablet into 30ml of sterile water. It's a difficult procedure for me with one functional hand and so 10ml would be much easier. Would this also do? (2mg/10cc)And how long can you work with the same syringe? Also I'm a bit afraid of getting UTI's using this procedure, is there a high risk? And one last question, most of the time when I have a UTI and I test my urine with multistix, the nitrites colour up. Is this a certain type of UTI that can be avoided? Thanks for the advice! Bke

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11-07-2003, 03:06 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,345	I know KLD has talked about intravesicular administration of ditropan but not detrol. You can check out this previous post for some answers that may apply to your question. http://carecure.org/forum/showpost.php?p=11233 I work mainly in the inpatient setting and don't have any experience with such an instillation. Has your urologist suggested this to you? Of course you need to do all instillations under their direction and advice. PLG

11-07-2003, 11:59 PM	#3
Bke Senior Member Join Date: Aug 2003 Location: Belgium Posts: 224	Thanks nurse, I've read all the posts on the forum about detrol/ditropan/intravesicular/augmentation/... but no answer to my questions. I went to my urologist about 2 weeks ago; he prescribed me the detrusitol but said it probably wouldn't do a thing for me. He made me another appointment next friday to discuss the effects and probably talk about an augmentation. So before I go back to talk about an augmentation I want to be sure there's no other options. Since the side effects of the oral intake are too 'annoying', I now wanted to try the intravesicular way for the other week. Just one week and then on friday discuss the 'hopefully positive' results with my urologist.

11-08-2003, 02:31 PM	#4
stephen212 Senior Member Join Date: Jul 2001 Location: New York City Posts: 5,293	Bke74, If you've read all the threads on intravesicular Ditropan on this site then you know I'm evangelical about this procedure. I'll try my best to answer some of your questions. I have no experience using Detrol intravesicularly. For starters, it's expensive; and unlike Ditropan, Detrol is not yet available in the US as a generic. Also, according to my urologist Detrol has never been proven to be more effective than Ditropan. Its selling point is that presumably its side effects are less intense -- for some people. Chemically, however, my understanding is that the two drugs are more similar than not. So, if you're going to begin instilling meds into your bladder, I would go with Ditropan (oxybutynin) despite your less than great results taking it orally. Can you explain why you're able to prepare a 10cc syringe, but not a 30cc syringe? IDo you feel an appreciable difference in weight between the two and thus it's more difficult for you to handle? I don't use sterile water to prepare my syringes; distilled H20 is inexpensive and readily available and, for all intents and purposes, IS sterile. It's sold in gallon (4 liter) containers, but I decant it into an easy to hold 1/2 liter-size pull-top bottle for easy handling. As for the amount of water: anything less than 30cc and there's a good chance that it won't be distributed to enough of the bladder wall to be effective. Unless you've got a Munchkin-size bladder, I don't think 10cc is enough. The type of syringe you use is also important. I use a Bard piston syringe (order no. 38470) because it's extremely easy to grip. Ane while you could probably use one syringe for several days, I use a new one every day because I can -- my insurance covers them. I don't do anything extraordinay to protect against UTIs: no meds, no supplements, no drinking gallons of H20/day, etc. I've been doing the Ditropan instillation thing for a few years now and, maybe I'm just lucky, but if I've gotten only one minor UTI. I wonder, maybe there's something about the Ditropan solution that actually protects against UTIs. Unfortunately there's a limit to explaining all of this in writing -- a demonstration is far preferable. Since that's not too likely, you're going to have to discover your way through trial and error. I was very close to needing an augmentation procedure. Discovering intravesicular ditropan has made the single greatest lifestyle difference in my 20 year post-SCI existence. I hope it works for you. [This message was edited by Stephen NYC on 11-08-03 at 11:10 PM.] [This message was edited by Stephen NYC on 11-09-03 at 02:24 PM.]

11-08-2003, 05:21 PM	#5
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	thanks, stephen for stepping in. I was hoping that you would. Wise.

11-09-2003, 10:17 AM	#6
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,345	Thanks Wise and Stephen ! PLG

11-10-2003, 08:17 AM	#7
Bke Senior Member Join Date: Aug 2003 Location: Belgium Posts: 224	Thanks Stephen, I also was hoping you, as the expert, would answer my questions. I've started with the procedure today. My mom is preparing the syringes now (with detrusitol). If/when it works, and there's good results, I'll try to find a method so that I can fill a 30cc syringe myself. I hope the results will be immediate cause I'm going to my urologist this friday and when there's no results, I guess an augmentation is the only option left... Thanks, Bke

11-10-2003, 08:45 AM	#8
crags Senior Member Join Date: May 2002 Posts: 1,021	using detrol intravesicular could be a waste of money. you're getting only a limited exposure to the medication as it bathes the bladder wall only for a short time while it gets immediately diluted with new urine and completely removed at the next cath. using a more expensive med may not give you any better result. i get syringes with a ring end or slip a string loop around the end so i can pull it up. someone can leave the 30 cc in a bottle for you, pop in a pill, wait till dissolved then proceed. i'm c7 and have it down.

11-13-2003, 10:53 AM	#9
Bke Senior Member Join Date: Aug 2003 Location: Belgium Posts: 224	:-( I've tried taking detrol intravesicularly for 3 1/2 days and I'm back to minimal volumes: 100ml, 200ml max. I'm a bit dissapointed; it was kind of my last hope before augmentation surgery, well second last. Tomorrow I'll ask my urologist about botox. I'm anxious to here my Dr's opinion and experience. Anyway, thanks again for your help Stephen. [This message was edited by Bke74 on 11-13-03 at 02:19 PM.]

11-13-2003, 06:17 PM	#10
stephen212 Senior Member Join Date: Jul 2001 Location: New York City Posts: 5,293	Bke, I've never heard of anyone instilling Detrol, so I'm not surprised to learn that it didn't work. It's still not clear to me, however, whether you've ever tried instilling Ditropan (oxybutyin). Isn't it worth a try before moving on to Botox (there's a lifetime limit to the number of botox shots you can get) or augmentation surgery?