The Effectiveness of Intravesical Oxybutynin, Propantheline, and Capsaicin in the Management of Neuropathic Bladder following Spinal Cord Injury

Abstract

The objective of this study was to compare the therapeutic response of intravesical oxybutynin, propantheline, and capsaicin in the treatment of neurogenic detrusor overactivity. Carried out in the Department of Physical Medicine and Rehabilitation at a university teaching hospital in India, patients acted as their own controls. Oxybutynin 5 mg in solution or propantheline 15 mg in solution and capsaicin were instilled intravesically in each patient. Urodynamic studies were done before and after the intravesical instillation of each drug. The nonparametric tests were used for statistical analysis. The efficacy of intravesical capsaicin in the treatment of neurogenic detrusor overactivity was statistically significant for reflex volume (RV) (p = 0.018), cystometric capacity (CC) (p = 0.0440), leak volume (LV) (p = 0.000), and leak frequency (LF) (p = 0.009). The Kruskal-Wallis test for paired sample comparing pre- and post-LV and LF for intravesical capsaicin was significant at 2nd week (p = 0.002 and 0.054, respectively). There was a significant difference in therapeutic response between intravesical oxybutynin, propantheline, and capsaicin in the treatment of detrusor overactivity for LV and LF at 2nd week (p = 0.017 and 0.003, respectively). When comparing responses of oxybutynin and propantheline, more subjects demonstrated improvement with intravesical propantheline than oxybutynin for RV, detrusor leak point pressure (LPP), clean intermittent catheterization volume (CICV), and LV. This study suggests that intravesical agents may be used as effective adjuvants in the management of incontinence due to neurogenic detrusor overactivity following spinal cord injury.

Capsaicin: Current Understanding of Its Mechanisms and Therapy of Pain and Other Pre-Clinical and Clinical Uses

“…The first possibility of clinical use of capsaicin in the treatment of urinary tract disorders was demonstrated using intravesical injection of a 100 mL of 1 mM (30 mg) solution of capsaicin (dissolved in alcohol and saline) in patients with multiple sclerosis that presented bladder detrusor hyperreflexia. The same dose has been used successfully in several studies of patients with neurogenic detrusor over activity after spinal cord injury or neurogenic bladder [267,268,269,270]. The use of alcohol as a solvent can cause irritation and become a limiting factor in the use of capsaicin, causing pelvic pain in more than 50% of patients as reviewed before [271].…”

Neurogenic bladder in spinal cord injury patients

“… 66 Intravesical therapy with oxybutynin has been shown to be effective and helps to reduce the systemic side effects associated with oral administration of this drug. 67 …”

Carbon nanotube-based electrochemical sensors for quantifying the ‘heat’ of chilli peppers: the adsorptive stripping voltammetric determination of capsaicin

“…4 Capsaicinoids possess some biological properties that can be beneficial for human health. [5][6][7] They have high antioxidant power, 8 in addition to anti-tumoral, 9 anti-mutagenic, 10,11 antibacterial 12, 13 and anticarcinogenic 9, 14 properties. They have also exhibited protective effects against cholesterol 15 and obesity, 16 and have also been used as topical analgesics for the treatment of some diseases, like post-herpetic neuralgia 17, 18 and gastrointestinal chemical hypersensitivity.…”