We performed a critical review of our "ten-year" experience with intravesical vanilloids (capsaicin and resiniferatoxin) in the treatment of neurogenic incontinence, to address the issue of their introduction into daily clinical practice. From July 1992 to June 2001, 54 patients suffering from detrusor hyperreflexia, due to spinal cord injury, received intravesical instillation of capsaicin and, from January 1995 to June 2001, 47 patients received intravesical instillation of resiniferatoxin (RTX) in order to treat the bladder dysfunction and symptoms. All patients presented a detrusor hyperreflexia refractory to oral and/or intravesical oxybutynin and displayed high voiding pressure associated with frequent urine leakage. Capsaicin was used at the concentration of 10 mM; RTX was tested in two different concentrations: 10 nM and 10 μM. The outcome was assessed according to the following parameters: 1) number of patients who reported an improvement of clinical status (patient dry during clean intermittent catheterization) and urodynamic status (a bladder capacity 50% higher than pre-treatment capacity, lasting more than 3 months after the instillation); 2) number of patients who continued the intravesical therapy; 3) number of instillations received; 4) the length of the interval between two consecutive instillations; and 5) outcome in patients not responding to vanilloid treatment. The topical intravesical instillation of capsaicin produced an improvement of symptoms and urodynamic parameters in 29 patients (53.7%) after 3 months. Of these 29 patients, only 7 (24.13%) continued to receive capsaicin at June 2001. The mean follow-up was 32.28 ± 14.20 months (range 8-52), the mean number of instillations was 6.14 ± 2.54 (range 2-10) and the mean interval between two consecutive instillations was 7.14 ± 2.60 months (range 4-12). The topical intravesical instillation of RTX produces an improvement of symptoms and urodynamic parameters in 73.33% of patients over a total of 45 patients who received 10μM. Eighteen of them (54.54%) continued to receive RTX at June 2001. The mean follow-up was 27.88 ± 10.95 months (range 11-49), the mean number of instillations was 4.33 ± 1.60 (range 2-8). The mean interval between two consecutive instillations was 9.61 ± 2.99 months (range 4-16). The results obtained using RTX seem to be very promising with regard to efficacy and tolerance, particularly in comparison with capsaicin. Even if the number of patients who received capsaicin and RTX remains small, intravesical vanilloid receptor agonist RTX could offer an effective alternative to oral medications in the treatment of neurogenic incontinence.
|Number of pages||6|
|Publication status||Published - Mar 2003|
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