Chancellor M B, de Groat W C
Department of Pharmacology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
J Urol. 1999 Jul;162(1):3-11. doi: 10.1097/00005392-199907000-00002.
Pharmacological treatment of the overactive bladder relies on partially blocking the efferent parasympathetic innervation to the detrusor with anticholinergic drugs. However, often these drugs have troublesome side effects and doses are insufficient to restore continence in patients with detrusor instability. We present the background, basic and clinical research with intravesical instillation of capsaicin and resiniferatoxin as treatments for the overactive bladder.
Capsaicin, the main pungent ingredient in hot peppers of the genus Capsicum, is a specific neurotoxin that desensitizes C fiber afferent neurons which may be responsible for signals that trigger detrusor overactivity.
In the last 6 years studies have demonstrated encouraging improvement in lower urinary tract symptoms with minimal long-term complications. Most of these studies have also demonstrated that the acute pain and irritation associated with capsaicin are major deterrents to widespread use. Therefore, resiniferatoxin, an ultra-potent analogue of capsaicin which appears to have similar efficacy but less acute side effects, may be more useful.
Intravesical capsaicin and resiniferatoxin are novel and promising treatments for the overactive bladder, with profound basic and clinical implications.
膀胱过度活动症的药物治疗依赖于使用抗胆碱能药物部分阻断传入逼尿肌的副交感神经传出神经支配。然而，这些药物常常有令人烦恼的副作用，且剂量不足以恢复逼尿肌不稳定患者的控尿能力。我们介绍了辣椒素和树脂毒素膀胱内灌注治疗膀胱过度活动症的背景、基础及临床研究。
辣椒素是辣椒属辣椒中的主要辛辣成分，是一种特异性神经毒素，可使可能负责触发逼尿肌过度活动信号的C纤维传入神经元脱敏。
在过去6年中，研究表明下尿路症状有令人鼓舞的改善，且长期并发症极少。这些研究大多还表明，与辣椒素相关的急性疼痛和刺激是其广泛应用的主要障碍。因此，树脂毒素作为一种超强效的辣椒素类似物，似乎具有相似的疗效，但急性副作用较少，可能更有用。
膀胱内灌注辣椒素和树脂毒素是治疗膀胱过度活动症的新型且有前景的方法，具有深远的基础和临床意义。
