Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications.
OBJECTIVE
To evaluate the safety and efficacy of intra-ureteric capsaicin for loin pain haematuria syndrome (LPHS).


METHODS
In an open prospective pilot study, four middle-aged patients (three women and one man) with LPHS resistant to therapies such as splanchnic nerve block, psychological treatment or renal autotransplantation (one) were assessed. An intra-ureteric infusion of capsaicin (30 mg/100 mL of 30% alcohol in saline) for 30 min with bladder irrigation was administered under general anaesthesia, with a subsequent intravenous patient-controlled narcotic analgesic pump for pain control. Double-concentration capsaicin was used for second infusions, if necessary when the response to the earlier infusion was inadequate or incomplete.


RESULTS
The first patient had experienced reduced pain levels for the first 3 months only, with no benefit from the subsequent treatments with higher doses of capsaicin (60 mg). The second patient with recurrent pain in an autotransplanted kidney had no benefit from either a 30 or 60 mg capsaicin infusion a month apart, but developed a fibrotic stricture at the transplant pelvi-ureteric junction, requiring pyelocystoplasty. The third patient with concurrent depression had no benefit from a 30-mg infusion of capsaicin. The fourth patient experienced no pain relief from a 30 mg infusion of capsaicin but developed proteinuria secondary to mesangial proliferative glomerulonephritis, ureteric inflammation needing stenting within 7 days of treatment and subsequently nephrectomy for a nonfunctioning kidney at 3 months.


CONCLUSIONS
Intra-ureteric capsaicin was neither effective nor safe in LPHS; the contribution of the alcohol diluent cannot be excluded.
Playford
D
D
Department of Urology, Royal Perth Hospital, Western Australia, Australia.
Kulkarni
H
H
Thomas
M
M
Vivian
J
J
Low
A
A
Mander
J
J
Perlman
D
D
Finch
P
P
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002211:Capsaicin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006417:Hematuria / Q000150:complications*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D010146:Pain / Q000188:drug therapy*; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011446:Prospective Studies; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D002211:Capsaicin