De Ridder D, Chandiramani V, Dasgupta P, Van Poppel H, Baert L, Fowler C J
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
J Urol. 1997 Dec;158(6):2087-92. doi: 10.1016/s0022-5347(01)68162-x.
We described the long-term outcome of intravesical capsaicin instillations in patients with urinary incontinence and compared its efficacy in 2 similar populations of patients with multiple sclerosis in a dual center study.
During 5 years 79 patients with intractable urinary incontinence have been treated with intravesical capsaicin. The majority of patients had spinal cord disease due to multiple sclerosis but 4 were neurologically normal. Cystometry was performed before and 4 to 6 weeks after intravesical instillation of 1 to 2 mmol./l. of capsaicin in 30% ethanol in saline. Instillations of vehicle (30% ethanol in saline) alone were carried out in 5 patients.
In patients with phasic detrusor hyperreflexia complete continence was achieved in 44%, satisfactory improvement occurred in 36% and treatment failed in 20%. Clinical benefit from a single instillation lasted 3 to 6 months and was repeated in some patients with similar improvement. Capsaicin was ineffective in patients with poor bladder compliance and in neurologically normal patients with sensory urgency and detrusor instability. There was no clinical or urodynamic improvement in patients treated with vehicle alone. There have been no long-term complications.
Our study shows that repeated instillations of intravesical capsaicin are effective in treatment of patients with detrusor hyperreflexia due to spinal cord disease and that effectiveness of the treatment persists at least 3 to 5 years.
我们描述了膀胱内注入辣椒素治疗尿失禁患者的长期疗效，并在一项双中心研究中比较了其在2组相似的多发性硬化症患者中的疗效。
5年间，79例顽固性尿失禁患者接受了膀胱内辣椒素治疗。大多数患者因多发性硬化症患有脊髓疾病，但有4例神经功能正常。在膀胱内注入1至2 mmol./l.辣椒素于30%乙醇生理盐水溶液之前以及之后4至6周进行膀胱测压。5例患者仅接受载体（30%乙醇生理盐水溶液）注入。
在伴有间歇性逼尿肌反射亢进的患者中，44%实现了完全控尿，36%有满意改善，20%治疗失败。单次注入的临床益处持续3至6个月，一些患者再次注入后有类似改善。辣椒素对膀胱顺应性差的患者以及神经功能正常但有感觉性尿急和逼尿肌不稳定的患者无效。仅接受载体治疗的患者无临床或尿动力学改善。无长期并发症。
我们的研究表明，重复膀胱内注入辣椒素对脊髓疾病所致逼尿肌反射亢进患者有效，且治疗效果至少持续3至5年。
