Intravesical Capsaicin as a Treatment for Refractory Detrusor Hyperreflexia: A Dual Center Study With Long-Term Followup

Ridder, Dirk De; Chandiramani, V.A.; Dasgupta, Prokar; Popple, H. Van; Baert, Luc; Fowler, Clare J.

doi:10.1016/s0022-5347(01)68162-x

Cited by 158 publications

(91 citation statements)

References 26 publications

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“…However, we did not con®rm the good results obtained by other studies, 3 but this datum may be due to di erent drug concentration, vehicle, duration and frequency of treatment. Fowler et al reported an improvement of clinical and urodynamical parameters also in patients su ering from Multiple Sclerosis (MS) and neurogenic urinary incontinence.…”

Section: Discussioncontrasting

confidence: 94%

“…The clinical outcome of intravesical capsaicin, in patients su ering from refractory detrusor hyperre¯exia, has been recently reviewed by a dual-centre study with a long term follow-up. 3 De Ridder reported that the e ectiveness of the treatment persisted at least 3 ± 5 years. Such results have not been con®rmed by other American studies, perhaps because of di erent drug concentration, vehicle, duration and frequency of treatment.…”

Section: Introductionmentioning

confidence: 99%

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Urodynamic assessment during intravesical infusion of capsaicin for the treatment of refractory detrusor hyperreflexia

Lazzeri

Spinelli²,

Beneforti

et al. 1999

Spinal Cord

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Purpose: Parameters to predict outcome and the urodynamic e ects during infusion of capsaicin, seem not to have been assessed in patients with chronic cord injury. We monitored bladder activity urodynamically during infusion of high dosage of capsaicin. Material and methods: Thirty patients, 18 women and 12 men (average age 29 years, range 20 ± 59 years), su ering from chronic spinal myelopathy, who presented a refractory detrusor hyperre¯exia, were studied. They received saline solution containing 10 73 M capsaicin at ā ow rate of 2 ml min 71 for 15 min (total volume 30 c.c.). The detrusor activity was monitored by a real-time cystometrogram during infusion and 15 min after the end of the infusion itself. New ®lling cystometrograms were recorded after 30 days and after 6 months. Results: We obtained a clinical and signi®cant urodynamic improvement in 15 of the 30 patients (50%), con®rming that intravesical capsaicin may represent a therapeutic option for a selected group of patients su ering from refractory detrusor hyperre¯exia due to chronic spinal upper motor neuron lesion. Best results were observed in patients who showed, during the infusion of capsaicin, early uninhibited bladder contractions which disappeared within 10 ± 12 min from the beginning of the infusion (desensitisation). The patients of this group presented a signi®cant increase of mean cystomanometric capacity after 6 months (from 190.7 to 396.7 ml). No signi®cant clinical or urodynamic improvement was observed in the group of patients in whom uninhibited activity of detrusor was recorded for all the time of infusion. Conclusion: Our results support the idea of a major complexity of spinal re¯ex in paraplegic patients and may o er a clue to explain the failure of therapy with capsaicin. The present results support a new approach in the treatment of detrusor hyperre¯exia. The ideal dosage and treatment interval are not at present established and further studies are needed to explain substantial di erences in the outcome according to di erent urodynamic responses.

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Section: Discussioncontrasting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Urodynamic assessment during intravesical infusion of capsaicin for the treatment of refractory detrusor hyperreflexia

Lazzeri

Spinelli²,

Beneforti

et al. 1999

Spinal Cord

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“…In humans, intravesical TRPV1 agonist (capsaicin and RTX) desensitization therapy is based on the concept that the C fiber-driven micturition reflex, which is inactive in the adult life, resumes control of micturition in both neurogenic and nonneurogenic cases of overactive bladder (reviewed in Szallasi and Fowler, 2002;Avelino and Cruz, 2006). In patients with neurogenic detrusor overactivity disorders, intravesical capsaicin (Lazzeri et al, 1996;De Ridder et al, 1997) or RTX (Cruz et al, 1997;Lazzeri et al, 2000;Kim et al, 2003;Silva et al, 2005Silva et al, , 2007 provides symptomatic relief by increasing bladder capacity and decreasing the number of daily incontinent episodes. In some patients, intravesical RTX even fully restores continence (Cruz et al, 1997).…”

Section: Transient Receptor Potential Channels As Therapeutic Targmentioning

confidence: 99%

Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine

2014

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“…70 Also, therapies that do not relieve obstruction yet affect visceral afferent nerves can be as effective for LUTS and abolishing unstable bladder contractions as those which relieve obstruction. 71 Evidence of neurogenic changes following BOO have also been observed in animal studies. In a study involving rats with urethral ligation, 20% of animals continued to have persistent hyperactive voiding after urethral deligation, even though their bladder weights had normalized.…”

Section: Comparative Ef®cacy Of the Current Agentsmentioning

confidence: 82%

α1-Adrenoceptor selectivity and the treatment of benign prostatic hyperplasia and lower urinary tract symptoms

Kirby

Lepor

et al. 2000

Prostate Cancer Prostatic Dis

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The storage (irritative) and voiding (obstructive) symptoms associated with benign prostatic hyperplasia are generally attributed to prostate enlargement and increased prostatic smooth muscle tone mediated by the prevailing a 1 -adrenoceptors in the bladder neck and prostate. This results in obstruction and subsequent secondary changes to the bladder. However, there is growing evidence that many of these symptoms may be due to changes in extraprostatic a 1 -adrenoceptors, possibly a 1D -adrenoceptors. Findings from the VA cooperative trial challenge the current theory that the common side effects associated with these agents are due to vascular action of a 1 -adrenoceptor blockers. Prostate Cancer and Prostatic Diseases (2000) 3, 76±83.

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Intravesical Capsaicin as a Treatment for Refractory Detrusor Hyperreflexia: A Dual Center Study With Long-Term Followup

Abstract: Our study shows that repeated instillations of intravesical capsaicin are effective in treatment of patients with detrusor hyperreflexia due to spinal cord disease and that effectiveness of the treatment persists at least 3 to 5 years.

Cited by 158 publications

References 26 publications

Urodynamic assessment during intravesical infusion of capsaicin for the treatment of refractory detrusor hyperreflexia

Urodynamic assessment during intravesical infusion of capsaicin for the treatment of refractory detrusor hyperreflexia

Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine

α1-Adrenoceptor selectivity and the treatment of benign prostatic hyperplasia and lower urinary tract symptoms

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