Haferkamp A, Hohenfellner M
Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Urologe A. 2006 Oct;45(10):1283-8. doi: 10.1007/s00120-006-1178-4.
Overactive bladder and urgency incontinence are common conditions generally treated with oral anticholinergic medication. Despite the development of new antimuscarinic substances, many patients are refractory to or cannot tolerate the oral therapy due to severe side effects. Intravesical instillation therapy can provide an alternative method to manage detrusor overactivity. Intravesical instillation of anticholinergics such as oxybutynin and trospium chloride can achieve cholinergic blockade without producing systemic side effects. Botulinum toxin type A injections into the detrusor have been shown to increase bladder capacity and to decrease detrusor overactivity for 6 or more months. Intravesical local anesthetics such as lidocaine and bupivacaine block the conduction of unmyelinated C fibers which results in an increase of functional bladder capacity. Intravesical capsaicin and resiniferatoxin also affect the afferent C fiber innervation of the bladder, leading to a decrease in detrusor overactivity and also an increased bladder capacity. The use of intravesical anticholinergics and of local anesthetic medications, both known for their short-term efficacy, is limited due to the necessity of daily intermittent catheterization. In conclusion, intravesical therapies can provide an alternative treatment for the management of overactive bladder.
膀胱过度活动症和急迫性尿失禁是常见病症，通常采用口服抗胆碱能药物进行治疗。尽管新型抗毒蕈碱药物不断涌现，但许多患者因严重副作用而对口服治疗无效或无法耐受。膀胱内灌注疗法可为治疗逼尿肌过度活动提供一种替代方法。膀胱内灌注奥昔布宁和氯化曲司氯铵等抗胆碱能药物可实现胆碱能阻滞，且不会产生全身性副作用。向逼尿肌注射A型肉毒杆菌毒素已被证明可增加膀胱容量，并在6个月或更长时间内减少逼尿肌过度活动。膀胱内注射利多卡因和布比卡因等局部麻醉药可阻断无髓鞘C纤维的传导，从而增加功能性膀胱容量。膀胱内注射辣椒素和树脂毒素也会影响膀胱传入C纤维的神经支配，导致逼尿肌过度活动减少，膀胱容量增加。膀胱内抗胆碱能药物和局部麻醉药虽都具有短期疗效，但由于需要每日间歇性导尿，其应用受到限制。总之，膀胱内灌注疗法可为膀胱过度活动症的治疗提供一种替代方案。
