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Phé V, Schneider MP, Peyronnet B, Abo Youssef N, Mordasini L, Chartier-Kastler E, Bachmann LM, Kessler TM. Intravesical vanilloids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review and meta-analysis. A report from the Neuro-Urology Promotion Committee of the International Continence Society (ICS). Neurourol Urodyn 2017; 37:67-82. [PMID: 28618110 DOI: 10.1002/nau.23314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/05/2017] [Indexed: 12/21/2022]
Abstract
AIMS To systematically assess all available evidence on efficacy and safety of vanilloids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS). METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane register, Embase, Medline, Scopus, (last search January 8, 2016). RESULTS After screening of 7848 abstracts, 4 randomized controlled trials (RCTs) and 3 prospective cohort studies were included. Pooled data from three RCTs evaluating intravesical capsaicin showed the standardized mean difference to be -2.16 (95% confidence interval [CI] -2.87 to -1.45) in incontinence episodes per 24 h and -0.54 (95%CI -1.03 to -0.05) in voids per 24 h. There was no statistically significant effect on maximum cystometric capacity and maximum storage detrusor pressure. Overall, adverse events were reported by >50% of the patients, most commonly were pelvic pain, facial flush, worsening of incontinence, autonomic dysreflexia, urinary tract infection and haematuria. Risk of bias and confounding was relevant in both RCTs and non-RCTs. CONCLUSIONS Preliminary data suggest that intravesical vanilloids might be effective for treating NLUTD in patients with MS. However, the safety profile seems unfavorable, the overall quality of evidence is low and no licensed substance is currently available warranting well-designed, adequately sampled and properly powered RCTs.
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Affiliation(s)
- Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.,Brain Research Institute, University of Zürich, and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland
| | | | - Nadim Abo Youssef
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Livio Mordasini
- Department of Urology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France
| | | | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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De Ridder D, Ost D, Van der Aa F, Stagnaro M, Beneton C, Gross-Paju K, Eelen P, Limbourg H, Harper M, Segal JC, Fowler CJ, Nordenbo A. Conservative bladder management in advanced multiple sclerosis. Mult Scler 2016; 11:694-9. [PMID: 16320730 DOI: 10.1191/1352458505ms1237oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anticholinergics and intermittent catheterization are the cornerstones of bladder management in early multiple sclerosis (MS). In advanced MS however, bladder management is based more on tradition than on evidence. Nurses seem to deal with catheter problems and chronic incontinence. Despite the abundant use of indwelling catheters, there is a lack for guidelines on catheter-induced problems. The psychosexual and social impact of bladder problems in advanced MS is often neglected. The international multidisciplinary special interest group on sexual, urological and bowel dysfunction in MS (SUBDIMS) as a special interest group of the Rehabilitation in Multiple Sclerosis (RIMS) was confronted with a high variability in practice and a lack of guidelines. A literature review was prepared during three multidisciplinary expert meetings. This review will be the basis of further initiatives to improve the urological treatment of patients with advanced MS.
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Affiliation(s)
- D De Ridder
- Department of Urology, University Hospitals KU Leuven, Belgium.
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Wenzler DL, Burks FN, Cooney M, Peters KM. Proof of Concept Trial on Changes in Current Perception Threshold After Sacral Neuromodulation. Neuromodulation 2014; 18:228-31; discussion 232. [DOI: 10.1111/ner.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/23/2014] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Frank N. Burks
- Department of Urology; Beaumont Health System; Royal Oak MI USA
- Department of Urology; Oakland University William Beaumont School of Medicine; Royal Oak MI USA
| | - Maureen Cooney
- Department of Urology; Beaumont Health System; Royal Oak MI USA
| | - Kenneth M. Peters
- Department of Urology; Beaumont Health System; Royal Oak MI USA
- Department of Urology; Oakland University William Beaumont School of Medicine; Royal Oak MI USA
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Gees M, Colsoul B, Nilius B. The role of transient receptor potential cation channels in Ca2+ signaling. Cold Spring Harb Perspect Biol 2010; 2:a003962. [PMID: 20861159 DOI: 10.1101/cshperspect.a003962] [Citation(s) in RCA: 310] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The 28 mammalian members of the super-family of transient receptor potential (TRP) channels are cation channels, mostly permeable to both monovalent and divalent cations, and can be subdivided into six main subfamilies: the TRPC (canonical), TRPV (vanilloid), TRPM (melastatin), TRPP (polycystin), TRPML (mucolipin), and the TRPA (ankyrin) groups. TRP channels are widely expressed in a large number of different tissues and cell types, and their biological roles appear to be equally diverse. In general, considered as polymodal cell sensors, they play a much more diverse role than anticipated. Functionally, TRP channels, when activated, cause cell depolarization, which may trigger a plethora of voltage-dependent ion channels. Upon stimulation, Ca2+ permeable TRP channels generate changes in the intracellular Ca2+ concentration, [Ca2+]i, by Ca2+ entry via the plasma membrane. However, more and more evidence is arising that TRP channels are also located in intracellular organelles and serve as intracellular Ca2+ release channels. This review focuses on three major tasks of TRP channels: (1) the function of TRP channels as Ca2+ entry channels; (2) the electrogenic actions of TRPs; and (3) TRPs as Ca2+ release channels in intracellular organelles.
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Affiliation(s)
- Maarten Gees
- KU Leuven, Department of Molecular Cell Biology, Laboratory Ion Channel Research, Campus Gasthuisberg, Herestraat 49, bus 802, Leuven, Belgium
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5
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Juszczak K, Ziomber A, Wyczółkowski M, Thor PJ. Hyperosmolarity alters micturition: a comparison of urinary bladder motor activity in hyperosmolar and cyclophosphamide-induced models of overactive bladder. Can J Physiol Pharmacol 2010; 88:899-906. [DOI: 10.1139/y10-072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hyperosmolar factors induce the neurogenic inflammatory response, leading to bladder overactivity (OAB). The aim of the study was to compare the bladder motor activity in a hyperosmolar and acute cyclophosphamide (CYP)-induced model of OAB. Furthermore, we set our sights on defining the most physiological model of OAB in experimental practice. Forty-two female rats were divided randomly into 5 groups. All animals underwent cystometry with the usage of isotonic saline or saline of increasing concentration. Acute chemical cystitis was induced by CYP to elicit OAB. The following cystometric parameters were analyzed: basal pressure, threshold pressure, micturition voiding pressure, intercontraction interval, compliance, functional bladder capacity, motility index, and detrusor overactivity index. CYP and hypertonic saline solutions induced OAB. Having been compared with CYP OAB, none of the rats infused with hypertonic solution exhibited macroscopic signs of bladder inflammation. The comparison of CYP and hyperosmolar models of OAB revealed that the greatest similarity existed between the 2080 mOsm/L OAB model and the acute CYP-induced model. We postulate that the 2080 mOsm/L model of OAB can be established as being a less invasive and more physiological model when compared with the CYP-induced OAB model. Additionally, it may also be a more reliable experimental tool for evaluating novel therapeutics for OAB as compared with CYP-induced models.
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Affiliation(s)
- Kajetan Juszczak
- Department of Pathophysiology, Medical College, Jagiellonian University, Czysta 18 Street, Cracow 31-121, Poland
- Department of Urology, Rydygier Memorial Hospital, Cracow, Poland
| | - Agata Ziomber
- Department of Pathophysiology, Medical College, Jagiellonian University, Czysta 18 Street, Cracow 31-121, Poland
- Department of Urology, Rydygier Memorial Hospital, Cracow, Poland
| | - Marek Wyczółkowski
- Department of Pathophysiology, Medical College, Jagiellonian University, Czysta 18 Street, Cracow 31-121, Poland
- Department of Urology, Rydygier Memorial Hospital, Cracow, Poland
| | - Piotr J. Thor
- Department of Pathophysiology, Medical College, Jagiellonian University, Czysta 18 Street, Cracow 31-121, Poland
- Department of Urology, Rydygier Memorial Hospital, Cracow, Poland
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Kabay S, Kabay SC, Yucel M, Ozden H, Yilmaz Z, Aras O, Aras B. The clinical and urodynamic results of a 3-month percutaneous posterior tibial nerve stimulation treatment in patients with multiple sclerosis-related neurogenic bladder dysfunction. Neurourol Urodyn 2009; 28:964-8. [PMID: 19373898 DOI: 10.1002/nau.20733] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sahin Kabay
- Faculty of Medicine, Department of Urology, Dumlupinar University, Kutahya, Turkey.
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Serati M, Salvatore S, Uccella S, Cardozo L, Bolis P. Is There a Synergistic Effect of Topical Oestrogens When Administered with Antimuscarinics in the Treatment of Symptomatic Detrusor Overactivity? Eur Urol 2009; 55:713-9. [PMID: 18584946 DOI: 10.1016/j.eururo.2008.06.051] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 06/12/2008] [Indexed: 11/30/2022]
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Affiliation(s)
- Shang-Gao Liao
- State Key Laboratory of Drug Research, Institute of Materia Medica, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, P. R. China
| | - Hua-Dong Chen
- State Key Laboratory of Drug Research, Institute of Materia Medica, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, P. R. China
| | - Jian-Min Yue
- State Key Laboratory of Drug Research, Institute of Materia Medica, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, P. R. China
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Everaerts W, Sepúlveda MR, Gevaert T, Roskams T, Nilius B, De Ridder D. Where is TRPV1 expressed in the bladder, do we see the real channel? Naunyn Schmiedebergs Arch Pharmacol 2009; 379:421-5. [PMID: 19153713 DOI: 10.1007/s00210-008-0391-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 12/30/2008] [Indexed: 11/29/2022]
Abstract
Transient receptor potential channel-vanilloid subfamily member 1 (TRPV1) is an important target in the treatment of bladder overactivity. This receptor is suggested to function as a mechanosensor in the normal bladder and to mediate the development of bladder overactivity during cystitis. Our aim was to determine the cellular distribution of TRPV1 in mouse and rat bladder tissue. We used three different commercial TRPV1 antibodies to perform immunohistochemistry on bladder tissue from rats and wild-type and TRPV1(-/-) mice, using trigeminal ganglia as a control tissue for TRPV1 expression. Although two of the antibodies seemed to react specifically in trigeminal ganglion tissue, all the antibodies produced a similar staining pattern in the urothelium of wild-type and TRPV1(-/-) mice. These data show that TRPV1 antibodies can cause an aspecific immunostaining in bladder tissue, urging for additional research to confirm the exact distribution of TRPV1 in bladder. In conclusion, we think that the use of negative controls on knockout mice, whenever available, is mandatory when conducting immunohistochemical localization studies.
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Affiliation(s)
- Wouter Everaerts
- Department of Surgery, Laboratory of Experimental Urology, Campus Gasthuisberg, KU Leuven, Herestraat 49, Bus 7003, 3000, Leuven, Belgium.
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10
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Liu L, Mansfield KJ, Kristiana I, Vaux KJ, Millard RJ, Burcher E. The molecular basis of urgency: regional difference of vanilloid receptor expression in the human urinary bladder. Neurourol Urodyn 2007; 26:433-8; discussion 439; discussion 451-3. [PMID: 17016800 DOI: 10.1002/nau.20326] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM Treatments targeting vanilloid receptor TRPV1 are effective in some bladder disorders. Our aim was to determine the expression profiles of TRPV1 in regions of human bladder and test the hypothesis that there would be an upregulation of TRPV1 in mucosa of patients with bladder hypersensitivity but not idiopathic detrusor overactivity (IDO). MATERIALS AND METHODS Women with sensory urgency (SU), interstitial cystitis (IC), and IDO were investigated by videourodynamics and cystoscopy. Control biopsies were used for comparison. Biopsies were dissected into mucosa and muscle, and evaluated for TRPV1 mRNA expression using quantitative competitive RT-PCR (QC-RT-PCR). RESULTS TRPV1 mRNA from SU trigonal mucosa was significantly higher than control trigonal mucosa or SU bladder body mucosa. In contrast, in IDO patients, there was no difference between trigonal mucosa and body mucosa. In IC biopsies, RNA quality was substandard and unable to be used for analysis. The most striking finding was that TRPV1 mRNA expressed in SU trigonal mucosa was significantly inversely correlated with the bladder volume at first sensation of filling during cystometry. No such relationship was seen for IDO trigonal mucosa. No difference was seen in bladder body mucosa from any disease groups compared with age-matched control. CONCLUSIONS The symptoms of SU were associated with the increased expression of TRPV1 mRNA in the trigonal mucosa. No upregulation or regional differences of TRPV1 mRNA were seen in IDO patients. TRPV1 may play a role in SU and premature first bladder sensation on filling.
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Affiliation(s)
- Lu Liu
- Department of Physiology & Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, Australia
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11
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de Sèze M, Ruffion A, Chartier-Kastler E. Chapitre C-l A - Traitement pharmacologique de l’hyperactivité détrusorienne neurologique : per os, en patch, en instillation endo-vésicale. Prog Urol 2007; 17:559-63. [PMID: 17622090 DOI: 10.1016/s1166-7087(07)92368-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional rehabilitation of neurourological patients always starts with patient education, retraining, and occupational therapy, possibly completed by medical treatments. In the light of a systematic review of the literature, the authors describe the various treatments that can be used orally and by intravesical instillation in these patients. They also describe treatments such as desmopressin or agents that increase sphincter pressure, which can sometimes be very useful to obtain stable clinical results that are satisfactory for the patient.
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Affiliation(s)
- M de Sèze
- Service de rééducation fonctionnelle, Centre hospitalo-universitaire de Bordeaux, France.
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12
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Seki N. [Update on and problems of the drug treatment for voiding dysfunction]. Nihon Yakurigaku Zasshi 2007; 129:368-73. [PMID: 17507774 DOI: 10.1254/fpj.129.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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13
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Schulte-Baukloh H, Knispel HH. Neuromodulatory therapies in female pelvic medicine and reconstructive surgery: biological agents. BJU Int 2006; 98 Suppl 1:50-60; discussion 61. [PMID: 16911604 DOI: 10.1111/j.1464-410x.2006.06311.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In recent years, important improvements in the management of patients with neurogenic or non-neurogenic detrusor overactivity and urge incontinence have been brought about by the introduction of vanilloids and botulinum toxins in urology. In this review we introduce the new therapeutic options, provides basic information, and summarize the results experienced so far.
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Affiliation(s)
- Heinrich Schulte-Baukloh
- Department of Urology, St. Hedwig Hospital, Teaching Hospital of University Hospital Charité, Berlin, Germany.
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Dmochowski RR. The puzzle of overactive bladder: controversies, inconsistencies, and insights. Int Urogynecol J 2006; 17:650-8. [PMID: 16362142 DOI: 10.1007/s00192-005-0032-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 09/21/2005] [Indexed: 11/24/2022]
Abstract
Overactive bladder (OAB) affects millions of individuals and may severely impair the quality of life of those affected. The contribution of human behavior to manifestations of this symptom complex remains poorly understood. Continued evolution of our understanding of the pathophysiology of OAB has identified contributory mechanisms, which in turn may open new therapeutic avenues. Recent improvements in drug delivery systems represent advances in the management of OAB. However, more complete symptom control with greater tolerability is desirable; this awaits the development of agents specific for newly emerging and as yet unidentified pathophysiologic pathways. Importantly, as understanding of outcomes assessment in OAB matures, refined assessments of disease severity, response to intervention, and patient preference should be possible.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urology, Vanderbilt University School of Medicine, Room A 1302, Medical Center North, Nashville, TN 37232, USA.
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Freeman RM, Adekanmi O, Waterfield MR, Waterfield AE, Wright D, Zajicek J. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Int Urogynecol J 2006; 17:636-41. [PMID: 16552618 DOI: 10.1007/s00192-006-0086-x] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 02/03/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test whether cannabinoids reduce urge incontinence episodes without affecting voiding in patients with multiple sclerosis. This was part of the multicentre trial of the Cannabinoids in Multiple Sclerosis (CAMS) study. SUBJECTS AND METHODS The CAMS study randomised 630 patients to receive oral administration of cannabis extract, Delta(9)-tetrahydrocannabinol (THC) or matched placebo. For this substudy subjects completed incontinence diaries. RESULTS All three groups showed a significant reduction, p<0.01, in adjusted episode rate (i.e. correcting for baseline imbalance) from baseline to the end of treatment: cannabis extract, 38%; THC, 33%; and placebo, 18%. Both active treatments showed significant effects over placebo (cannabis extract, p=0.005; THC, p=0.039). CONCLUSION The findings are suggestive of a clinical effect of cannabis on incontinence episodes in patients with MS. This is in contrast to the negative finding of the CAMS study, where no difference was seen in the primary outcome of spasticity.
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Affiliation(s)
- R M Freeman
- Urogynaecology Unit, Derriford Hospital, Plymouth, Devon, UK.
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Vignes JR, De Seze M, Dobremez E, Joseph PA, Guérin J. Sacral neuromodulation in lower urinary tract dysfunction. Adv Tech Stand Neurosurg 2006; 30:177-224. [PMID: 16350455 DOI: 10.1007/3-211-27208-9_5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vesico-urethral dysfunction is a major problem in daily medical practice due to its psychological disturbances, its social costs and its high impact on quality of life. Recently, sacral neuromodulation, namely the electrical stimulation of the sacral nerves, appears to have become an alternative for radical bladder surgery particularly in cases of idiopathic bladder overactivity. The mechanism of action is only partially understood but it seems to involve a modulation in the spinal cord due to stimulation of inhibitory interneurons. Temporary sacral nerve stimulation is the first step. It comprises the temporary application of neuromodulation as a diagnostic test to determine the best location for the implant and to control the integrity of the sacral root. If test stimulation is successful, a permanent device is implanted. This procedure is safe in experienced hands. So-called idiopathic bladder overactivity still the major indication for this technique. Patients not likely to benefit from the procedure were those with complete or almost complete spinal lesions, but incomplete spinal lesions seemed to be a potential indication. This technique is now also indicated in the case of idiopathic chronic retention and chronic pelvic pain syndrome. When selection is performed, more than three-quarters of the patients showed a clinically significant response with 50% or more reduction in the frequency of incontinent episodes, but the results vary according to the author's mode of evaluation. From the economic point of view, the initial investment in the device is amortized in the mid-term by savings related to lower urinary tract dysfunction. Finally, this technique requires an attentive follow-up and adjustments to the electric parameters so as to optimize the equilibrium between the neurological systems.
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Affiliation(s)
- J R Vignes
- Department of Neurosurgery, Medical School Hospital, Hôpital Pellegrin, Bordeaux, France
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Abstract
The overactive bladder is a common condition, which has significant effects on quality of life. The aetiology in most cases is unknown, and treatment outcomes have until recently been unsatisfactory. Management includes excluding pathology and implementing behavioural changes such as caffeine reduction, bladder and pelvic floor training, as well as antimuscarinic drug therapy. Compliance is often problematic, and this can be improved with some of the newer antimuscarinics with fewer side-effects, and a good therapist/patient relationship. In the majority of cases this 'treatment package' is successful, but in those where it is not, intravesical therapies have been introduced, e.g. neuromodulation, alternative drug therapies (e.g. vanilloids, botox) and surgery. With a better understanding of the aetiology and identification of risk factors better outcomes from treatment are likely.
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Affiliation(s)
- R M Freeman
- Urogynaecology Unit, Directorate of Obstetrics and Gynaecology, Derriford Hospital, Plymouth PL6 8DH, UK.
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Blyweert W, Aa F, Ost D, Stagnaro M, Ridder D. Interstitial cells of the bladder: the missing link? BJOG 2004; 111:57-60. [PMID: 15663383 DOI: 10.1111/j.1471-0528.2004.00469.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wim Blyweert
- Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium
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Lazzeri M, Spinelli M, Zanollo A, Turini D. Intravesical Vanilloids and Neurogenic Incontinence: Ten Years Experience. Urol Int 2004; 72:145-9. [PMID: 14963356 DOI: 10.1159/000075969] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2002] [Accepted: 03/28/2003] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study we critically review our '10-year' experience with intravesical vanilloids (capsaicin and resiniferatoxin) in the treatment of neurogenic incontinence, addressing the issue of their introduction into daily clinical practice. MATERIALS AND METHODS From July 1992 to June 2001, 54 patients suffering from detrusor hyperreflexia, due to spinal cord injuries, received intravesical instillation of capsaicin, and from January 1995 to June 2001, 47 patients received intravesical instillation of resiniferatoxin (RTX) in order to treat bladder dysfunction and symptoms. All patients presented detrusor hyperreflexia refractory to oral and/or intravesical oxibutynin and they displayed high-voiding pressure associated with frequent urine leakage. Capsaicin was used at a concentration of 10 mM; RTX was tested in two different concentrations: 10 nM and 10 microM. The outcome was considered according to simple parameters: (i) the number of patients who reported an improvement in clinical status (patient dry between clean intermittent catheterization) and urodynamic status (a bladder capacity 50% higher than pretreatment capacity, lasting more than 3 months after the instillation); (ii) the number of patients who continued intravesical therapy; (iii) the number of instillations they received; (iv) the length of the interval between 2 consecutive instillations, and (v) alternative therapies when vanilloids failed. RESULTS The topical intravesical instillation of capsaicin produced an improvement in symptoms and urodynamic parameters, in 29 patients (53.7%) after 3 months. In these 29 patients only 7 (24.13%) continued to received capsaicin in June 2001. The mean follow-up was 32.28 +/- 14.20 (range 8-52) months, the mean number of instillations was 6.14 +/- 2.54 (range 2-10) and the mean interval between the 2 consecutive instillations was 7.14 +/- 2.60 (range 4-12) months. The topical intravesical instillation of RTX produced an improvement in symptoms and urodynamic parameters in 73.33% of patients (a total of 45 patients) who received 10 microM. 18 of them (54.54%) continued to received RTX in June 2001. The mean follow-up was 27.88 +/- 10.95 (range 11-49) months, the mean number of instillations was 4.33 +/- 1.60 (range 2-8). The mean interval between 2 consecutive instillations was 9.61 +/- 2.99 (ranged 4-16) months. CONCLUSION The results obtained using RTX seem to be very promising with regard to efficacy and tolerance, particularly in comparison with capsaicin. Even if the number of patients who received capsaicin and RTX remains small, the intravesical vanilloid receptor agonist RTX could offer an attractive alternative to oral medications in the treatment of neurogenic incontinence.
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Affiliation(s)
- Massimo Lazzeri
- Department of Urology, 'Casa di Cura Santa Chiara Firenze', Florence, Italy.
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Abstract
This article summarizes current thought regarding the efficacy of various types of drug therapy for incontinence in women, borrowing liberally from similar previous presentations. Space limitations for this chapter necessitate some simplification and condensation of these subjects. References have generally been chosen because of their informational or review content and not because of originality or initial publication on a particular subject.
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Affiliation(s)
- Alan J Wein
- Division of Urology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Rhoads, Philadelphia, PA 19104, USA.
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Szallasi A, Fowler CJ. After a decade of intravesical vanilloid therapy: still more questions than answers. Lancet Neurol 2002; 1:167-72. [PMID: 12849485 DOI: 10.1016/s1474-4422(02)00072-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Vanilloid sensitivity is a functional signature of a subset of unmyelinated fibres innervating the urinary bladder. The role that these nerves have in the physiological control of storage and voiding is unclear. However, after the bladder has been disconnected by spinal injury from the pontine micturition centre, vanilloid-sensitive fibres assume a central role in the reflex emptying of the bladder that occurs at low volumes. Intravesical vanilloid (capsaicin or resiniferatoxin) administration is beneficial in this disorder by "desensitising" these nerves. Resiniferatoxin is superior to capsaicin in terms of its tolerability profile. Investigators are moving rapidly to identify the mechanisms by which desensitisation to vanilloids occurs. Vanilloids induce lasting, but fully reversible, changes in gene expression, including downregulation of the vanilloid receptor subtype 1. It is hoped that application of gene chip technologies will address the global profile of vanilloid-induced changes in gene expression and their relative contribution to desensitisation. Drugs that target signalling mechanisms that bring about these changes in gene expression have obvious therapeutic potential.
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Affiliation(s)
- Arpad Szallasi
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO 63110, USA.
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