Fowler C J, Beck R O, Gerrard S, Betts C D, Fowler C G
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
J Neurol Neurosurg Psychiatry. 1994 Feb;57(2):169-73. doi: 10.1136/jnnp.57.2.169.
An intravesical instillation of 100 ml 1 or 2 mmol/l capsaicin has been used to treat detrusor hyperreflexia giving rise to intractable urinary incontinence in 12 patients with spinal cord disease and two other patients with detrusor overactivity of non-spinal origin. Nine patients, all of whom had spinal cord disease, showed some improvement in bladder function. The benefit was only shortlived and partial in four, but the remaining five achieved complete continence while performing intermittent self catheterisation. Urodynamic studies in these nine patients showed an increase in mean (SD) bladder capacity from 106 (57) to 302 (212) ml and a fall in the maximum detrusor pressure from 54 (20) to 36 (10) cm of water. There were no short term ill effects from the instillation and the improvement in bladder function lasted for between three weeks to six months, when in some patients it was repeated. The improvement in bladder behaviour shown in this study can be interpreted as showing that capsaicin sensitive afferents play an important part in the pathogenesis of detrusor hyperreflexia in spinal humans. Intravesical capsaicin seems a promising means of treating intractable detrusor hyperreflexia and studies with this substance may shed new light on other disorders of detrusor activity that cause incontinence.
对12例脊髓疾病患者及另外2例非脊髓源性逼尿肌活动亢进患者，采用膀胱内灌注100 ml 1或2 mmol/l辣椒素治疗导致顽固性尿失禁的逼尿肌反射亢进。9例患者均患有脊髓疾病，其膀胱功能有一定改善。4例患者的改善只是短暂且部分性的，但其余5例在进行间歇性自我导尿时实现了完全控尿。对这9例患者进行的尿动力学研究显示，平均（标准差）膀胱容量从106（57）ml增加到302（212）ml，最大逼尿肌压力从54（20）cm水柱降至36（10）cm水柱。灌注没有短期不良影响，膀胱功能的改善持续了3周至6个月，部分患者在此期间进行了重复治疗。本研究中膀胱行为的改善可以解释为表明辣椒素敏感传入神经在脊髓损伤患者逼尿肌反射亢进的发病机制中起重要作用。膀胱内灌注辣椒素似乎是治疗顽固性逼尿肌反射亢进的一种有前景的方法，对该物质的研究可能会为导致尿失禁的其他逼尿肌活动障碍带来新的启示。
