Intravesical instillation of capsaicin in urology: A review of the literature.
OBJECTIVE
Interest in the intravesical instillation of capsaicin is growing among urologists. Its efficacy on detrusor hyperreflexia, hypersensitive bladder disorders and bladder pain has been reported in several studies. However, the lack of common evaluation parameters and the absence of consensus concerning a protocol of instillation hamper the interpretation of results. The purpose of this review is to better delineate the indications and optimum protocol for intravesical use of capsaicin.


METHODS
Eight open and two placebo-controlled human clinical trials were analyzed. All 200 patients involved had lower urinary tract disorders.


RESULTS
Clinical or urodynamic symptoms improved in 84.3% of the patients who received intravesical capsaicin for neurogenic hyperreflexic bladder, a significantly greater efficacy than that of placebo. Capsaicin may also be beneficial in patients who have non-neurogenic disorders. Whether or not the patients has a neurologic deficit, side effects appear during and in the period immediately following instillation.


CONCLUSIONS
Intravesical capsaicin appears to be indicated in neurogenic hyperreflexic bladder, but is less effective against detrusor instability, hypersensitive bladder disorders or pelvic pain. The best instillation protocol and long-term tolerance remain to be established.
de Sèze
M
M
Service de Rééducation Fonctionnelle Neurologique, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin Tastet-Girard, Bordeaux, France. m.deseze@aol.fr
Wiart
L
L
Ferrière
J
J
de Sèze
M P
MP
Joseph
P
P
Barat
M
M
D000283:Administration, Intravesical; D000293:Adolescent; D000328:Adult; D000368:Aged; D002211:Capsaicin / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017699:Pelvic Pain / Q000188:drug therapy; D012021:Reflex, Abnormal / Q000187:drug effects; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000209:etiology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy; D014563:Urodynamics
D002211:Capsaicin