[Reiterated intravesical instillation of capsaicin in neurogenic detrusor hyperreflexia: a 5-years experience of 100 instillations].
BACKGROUND
Capsaicin is a topic and specific C-fiber afferent neurotoxic. After spinal-cord injury, C-fiber afferent proliferate in the bladder mucosae and are involving in detrusor hyperreflexia


OBJECTIVE
To investigate middle-term efficacy and tolerance of intravesical instillation of capsaïcin in spinal-cord injured patients presenting severe urinary incontinence refractory to usual therapy due to detrusor hyperreflexia.


METHODS
Thirty patients receveid a first intravesical instillation of 1mMol/L Capsaïcin solution in 30% alcohol. The efficacy (voiding diary, pads, quality of life, maximum cystometric capacity, maximum detrusor pressure, first and normal desire to void) and tolerance were evaluated before, 1 month and 3 months after each instillation, completed by anual cystoscopy. In patients who responded favorably to this instillation, repeated instillations were proposed when symptoms recurred.


RESULTS
25 patients (83.3%) were improved after the initial instillation (decrease of incontinence-frequency-urgency, best quality of life, rise on maximal cystometric capacity), since the 15(th) day and for 3.2 months. 76 reiterative instillations were performed in 22 patients (2 to 9 instillations per patient). 91.2% of them remained successfull, during an average period of 4.2 months. It does not appear loss of benefits after iterative instillations. Transient and moderate adverse effects followed 86% and 79% of the first and reiterated instillation (exacerbation of incontinence, supra-pubic pain). Two patients have presented a begnin and transient inflammatory cystitis after reiterated instillation.


CONCLUSIONS
Intravesical instillation of capsaïcin are an effective treatment for incontinence and associated symptoms caused by neurogenic detrusor hyperactivity. Propositions to improve immediate tolerance are debated.
de Sèze
M
M
Service de médecine physique et réadaptation, centre hospitalier universitaire de Bordeaux, hôpital Pellegrin Tastet-Girard, 33076 cedex, Bordeaux, France. madeseze@club-internet.fr
Wiart
L
L
de Sèze
M P
MP
Joseph
P A
PA
Brochet
B
B
Ferrière
J M
JM
Mazaux
J M
JM
Barat
M
M
D000283:Administration, Intravesical; D000328:Adult; D002211:Capsaicin / Q000008:administration & dosage*; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009187:Myelitis / Q000150:complications; D010264:Paraplegia / Q000150:complications; D011446:Prospective Studies; D011782:Quadriplegia / Q000150:complications; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D014555:Urination Disorders / Q000188:drug therapy* / Q000209:etiology
D002211:Capsaicin
Capsaïcine intravésicale et hyperréflexie du détrusor. Expérience de 100 instillations sur une période de cinq ans.