Fraser Matthew O, Lavelle John P, Sacks Michael S, Chancellor Michael B
Rev Urol. 2002 Winter;4(1):1-11.
The incidence of urinary incontinence and overactive bladder problems will continue to grow as the population ages. Future treatments are likely to include an implantable drug delivery system, gene therapy, and the intravesical use of the vallinoids capsaicin and resiniferatoxin (RTX). An understanding of the urothelium is essential for effective design of these therapies. Intravesical anticholinergic drug treatment is currently not widely used, but intravesical pumps are under development to provide less cumbersome treatment methods and will provide nonsurgical options for patients who cannot tolerate oral anticholinergic agents. Research on the use of capsaicin as an intravesicular drug has had limited success, but trials have confirmed the efficacy of intravesical capsaicin for detrusor hyperreflexia. RTX is as effective as capsaicin but without side effects, such as pain and inflammatory neuropeptide release. RTX treatment may eliminate the need for surgical and other drug treatments of lower urinary tract dysfunction in patients with spinal cord injuries. Gene therapy will change the practice of urology by addressing the deficiencies that cause symptoms rather than attacking the symptoms themselves.
随着人口老龄化，尿失禁和膀胱过度活动症问题的发病率将持续上升。未来的治疗方法可能包括植入式药物递送系统、基因治疗，以及膀胱内使用辣椒素和树脂毒素（RTX）等香草素类物质。了解膀胱上皮对于有效设计这些疗法至关重要。膀胱内抗胆碱能药物治疗目前尚未广泛应用，但膀胱内泵正在研发中，以提供更简便的治疗方法，并为无法耐受口服抗胆碱能药物的患者提供非手术选择。将辣椒素用作膀胱内药物的研究取得的成功有限，但试验已证实膀胱内辣椒素对逼尿肌反射亢进有效。RTX与辣椒素效果相同，但无疼痛和炎性神经肽释放等副作用。RTX治疗可能使脊髓损伤患者无需对下尿路功能障碍进行手术和其他药物治疗。基因治疗将通过解决导致症状的缺陷而非仅仅针对症状本身，改变泌尿外科的治疗方式。
