Capsaicin and neurogenic detrusor hyperreflexia: A double-blind placebo-controlled study in 20 patients with spinal cord lesions

Sèze, M. de; Wiart, L.; Joseph, Pierre-Alain; Dosque, Jean-Pierre; Mazaux, Jean-Michel; Barat, M.

doi:10.1002/(sici)1520-6777(1998)17:5<513::aid-nau7>3.0.co;2-g

Cited by 105 publications

(75 citation statements)

References 14 publications

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“…When instilled as a control, 30% ethanol causes side effects, namely bladder inflammation, that are indistinguishable from side effects caused by ethanol with capsaicin, while onset is rapid ("immediate") and the adverse effects persist for 1 to 2 weeks. 16 The luminal plasma membrane of the urothelial cells is no barrier to the membrane fluidizing effects of ethanol, 22 which moves intracellularly, entraining its solubilized capsaicin. Alcohol induced tissue damage ensues, followed by the inflammatory cascade, including mediators of inflammation that induce the excitation of capsaicin sensitive neurons.…”

Section: Discussionmentioning

confidence: 84%

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Intravesical Capsaicin Versus Resiniferatoxin In Patients With Detrusor Hyperreflexia: A Prospective Randomized Study

et al. 2002

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Purpose: Capsaicin and resiniferatoxin (Sigma Chemical Co., St. Louis, Missouri) administered intravesically are attractive options for treating detrusor hyperreflexia. Because the 2 agents differ in chemical structure and relative potency, possible differences in their clinical and urodynamic effects were investigated in this prospective comparative study.Materials and Methods: A group of 24 spinal cord injured patients with refractory detrusor hyperreflexia were randomly assigned to receive a single dose of 2 mM. capsaicin in 30 ml. ethanol plus 70 ml. 0.9% sodium chloride or 100 nM. resiniferatoxin in 100 ml. 0.9% sodium chloride. Dwell time was 40 minutes with urodynamic monitoring. Urodynamics were performed at baseline before treatment, and after followups of 30 and 60 days. The frequency of daily catheterizations, incontinence episodes and side effects was recorded.Results: There was no significant urodynamic or clinical improvement in the capsaicin arm at 30 and 60 days of followup. In the resiniferatoxin arm the mean uninhibited detrusor contraction threshold plus or minus standard deviation increased from 176 Ϯ 54 to 250 Ϯ 107 ml. at 30 days (p Ͻ0.05) and to 275 Ϯ 98 ml. at 60 days (p Ͻ0.01). Mean maximum bladder capacity increased from 196 Ϯ 75 to 365 Ϯ 113 ml. at 30 days (p Ͻ0.001) and to 357 Ϯ 101 ml. at 60 days (p Ͻ0.001). Daily catheterizations and incontinent episodes were significantly decreased at 30 and 60 days of followup. Autonomic dysreflexia, limb spasms, suprapubic discomfort and hematuria developed in most patients who received capsaicin but in none who received resiniferatoxin.Conclusions: Intravesical administration of resiniferatoxin is superior to that of capsaicin in terms of urodynamic results and clinical benefits in spinal cord injured patients and it does not cause the inflammatory side effects associated with capsaicin.

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Section: Discussionmentioning

confidence: 84%

“…de Seze et al reported disease duration but the majority of their patients had multiple sclerosis. 16 Simply stated too many independent variables are involved to make general comparisons. Specifically the only comparable investigations were those of Geirsson et al 18 Using 2 mM.…”

Section: Discussionmentioning

confidence: 99%

Intravesical Capsaicin Versus Resiniferatoxin In Patients With Detrusor Hyperreflexia: A Prospective Randomized Study

et al. 2002

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“…Since this first report at least 12 studies were published but only two were randomised placebo-controlled trials. 12,13 Both studies tested the effects of 30 mg capsaicin in 30% ethanol versus ethanol alone and found that intravesical capsaicin significantly improved clinical and urodynamic parameters in patients with neurogenic detrusor overactivity. In contrast, another placebocontrolled crossover study could not find 1 mmol capsaicin superior to saline.…”

Section: Intravesical Capsaicinmentioning

confidence: 51%

Intravesical therapy options for neurogenic detrusor overactivity

Reitz

Schurch

2004

Spinal Cord

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Objectives: This review considers intravesical treatment options of neurogenic detrusor overactivity and discusses the underlying mechanism of action, clinical safety and efficacy, and the future trends. Methods: The available literature was reviewed using medline services. Results: Oral anticholinergic drugs are widely used to treat detrusor overactivity, but they are ineffective in some patients or cause systemic side effects such as blurred vision or dry mouth. As an alternative, topical therapy strategies have been suggested to achieve a profound inhibition of the overactive detrusor and to avoid high systemic drug levels. Currently available intravesical treatment options either act on the afferent arc of the reflex such as local anaesthetics or vanilloids or on the efferent cholinergic transmission to the detrusor muscle such as intravesical oxybutynin or botulinum toxin. Although an established and effective therapy, intravesical oxybutynin is not widely used. Evidence for clinical significance of intravesical atropine and local anaesthetic is missing. Intravesical capsaicin has been shown to improve clinical and urodynamic parameters, but cause pain in some patients. The intravesical instillation of resiniferatoxin and the injection of botulinum-A toxin into the detrusor muscle are promising new options; however, randomised placebo-controlled studies to prove their safety and efficacy are still missing. Conclusion: Intravesical treatment strategies in patients with neurogenic detrusor overactivity may provide alternatives to established therapies such as oral anticholinergics. The selectivity of the intravesical treatment and the reduction or even the absence of side effects are major advantages of this topical approach.

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“…Clinically, desensitization of C fibers is an effective treatment for bladder overactivity induced by different neurological diseases. 17,[27][28][29] In this study, we found that Gosha-jinki-gan partially reduced the neurokinin A, neurokinin B, substance P, TRPV1 receptors, and P2X3 purine receptors, which are functionally associated with C fibers in the urinary bladder.…”

Section: Discussionmentioning

confidence: 99%

Gosha‐jinki‐gan reduces transmitter proteins and sensory receptors associated with C fiber activation induced by acetic acid in rat urinary bladder

Imamura

Ishizuka

Aizawa

et al. 2008

Neurourology and Urodynamics

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Aims: We determined if Gosha-jinki-gan, a traditional Chinese herbal mixture, reduced the presence of the tachykinins neurokinin A, neurokinin B, and substance P, as well as the transient receptor potential vanilloid 1 (TRPV1) and P2X3 purine receptors that are functionally associated with C fibers in the urinary bladder. Methods: Thirty-six female rats were fed with either a standard diet or one supplemented with 1.08% Gosha-jinki-gan. After 4 weeks, the urinary bladders were instilled with either saline or 0.1% acetic acid. After 30 minutes, the bladders were removed and expression of the tachykinins and the TRPV1 and P2X3 receptors was determined by immunohistochemistry and mRNA expression. Results: In rats fed with the standard diet, the tachykinins and the TRPV1 and P2X3 receptors expressed nearby or within urothelium of the acetic acid-treated rats increased compared with the saline-instilled rats. In rats pretreated with Gosha-jinki-gan, the tachykinins and the TRPV1 and P2X3 receptors in the acetic acid-treated rats also increased compared with the saline-instilled rats. However, with the instillation of acetic acid, the tachykinins and the TRPV1 and P2X3 receptors of Gosha-jinki-gan pretreated rats decreased compared with standard diet fed rats. The mRNA expression levels of neurokinin A, substance P, and the TRPV1 receptor in acetic acid-treated Gosha-jinki-gan pretreated rats were lower than that in acetic acid-treated standard diet fed rats. Gosha-jinki-gan did not destroy nerve fibers within the bladders. Conclusions: Gosha-jinki-gan partially reduced the tachykinins and TRPV1 and P2X3 purine receptors without destroying the nerve fibers.(247/250 words) 3

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Capsaicin and neurogenic detrusor hyperreflexia: A double-blind placebo-controlled study in 20 patients with spinal cord lesions

Cited by 105 publications

References 14 publications

Intravesical Capsaicin Versus Resiniferatoxin In Patients With Detrusor Hyperreflexia: A Prospective Randomized Study

Intravesical Capsaicin Versus Resiniferatoxin In Patients With Detrusor Hyperreflexia: A Prospective Randomized Study

Intravesical therapy options for neurogenic detrusor overactivity

Gosha‐jinki‐gan reduces transmitter proteins and sensory receptors associated with C fiber activation induced by acetic acid in rat urinary bladder

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