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

Abstract

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.

Multiple intravesical instillation of low‐dose resiniferatoxin is effective in the treatment of detrusor overactivity refractory to anticholinergics

“…Data which may explain the reasons for the ineffectiveness of resiniferatoxin in treating DO are limited. That vanilloid‐sensitive fibres are not predominant in mediating detrusor reflex, and inadequate desensitization of vanilloid receptors on sensory fibres might be responsible for the poor therapeutic results [25]. A previous study showed that patients with an initial detrusor response of high‐amplitude detrusor contractions with a gradually disappearing contractility have a favourable therapeutic outcome from resiniferatoxin, suggesting adequate desensitization can provide effective suppression of DO caused by vanilloid receptor over‐expression [3,25].…”

Intravesical Vanilloids and Neurogenic Incontinence: Ten Years Experience

“…All patients presented detrusor hyperreflexia refractory to oral and/or intravesical oxibutynin and they displayed high voiding pressure associated with frequent urine leakage. The inclusion criteria for the patients' enrollment have been reported previously [8].…”

Afferents and lower urinary tract symptoms: Pathophysiology and future afferent therapy

“…De Ridder et al [20] reported that repeated instillations of intravesical capsaicin were effective in about 80% of patients with bladder overactivity due to spinal cord disease, with the benefi cial effect lasting 3 to 5 years. At the end of the 1990s, we questioned the effi cacy and safety of capsaicin for the management of detrusor hyperrefl exia [21]. Petersen et al [22] demonstrated in a placebo-controlled crossover study that intravesical treatment with capsaicin did not show benefi cial effects on detrusor hyperrefl exia and produced signifi cant reactive changes in the bladder mucosa.…”