Role of C afferent fibers and monitoring of intravesical resiniferatoxin therapy for patients with idiopathic detrusor overactivity
Role of C afferent fibers and monitoring of intravesical resiniferatoxin therapy for patients with idiopathic detrusor overactivity
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DOI：
10.1097/01.ju.0000132769.71014.b5
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发表时间：
2004-08-01
影响因子：
6.6
通讯作者：
Kumon, H
中科院分区：
文献类型：
--
作者：
Yokoyama, T;Nozaki, K;Kumon, H
目的：树脂毒素（Resiniferatoxin，RTX）是一种特异性的C纤维神经毒素，具有脱敏作用.在这项研究中，我们对特发性逼尿肌过度活动的患者进行膀胱内RTX治疗。此外，我们测量了治疗前后的C和A5纤维的电流感知阈值，以评估临床significant.Materials和方法：该协议涉及的RTX溶液（100毫升的50纳米）滴入膀胱30分钟。4名男性和6名女性接受了治疗，年龄在59至75岁之间。在治疗前和治疗后30天通过膀胱测压和神经测量仪（Neurotron，Inc.，巴尔的摩、马里兰州）。主观和客观的措施包括膀胱日记和生活质量治疗前，7，30和90天后，结果：10例患者中5个注意到改善，其中2人成为干燥。其他5例患者被认为具有静止症状。平均最大膀胱测压容量SD从基线时的229 ± 108 ml增加至30天时的271 ± 99.5 ml（p = 0.04）。尿失禁的平均每日发作次数从3.5 +/- 2.2减少到7天时的2.0 +/- 1.6（p = 0.008），30天时的1.9 +/- 1.6（p = 0.018）和90天时的2.5 +/- 1.7（p = 0.018）。C和A8纤维的平均电流感知阈值没有显著变化，分别从46.9 +/- 35.2至56.4 +/- 32.1（p = 0.161）和从66.9 +/- 31.7至66.4 +/- 25.2（p = 0.952）。然而，所有患者的C纤维值增加，从46.2 +/- 33.2改善到64.0 +/- 36.8（p = 0.043）。结论：膀胱内RTX改善了特发性逼尿肌过度活动患者的膀胱容量和漏尿发作。膀胱内RTX是一种有前途的治疗这种情况。
Purpose: Resiniferatoxin (RTX) is a specific C fiber neurotoxin which produces desensitization. In this study we performed intravesical RTX therapy in patients with idiopathic detrusor overactivity. In addition we measured the current perception threshold of C and A 5 fibers before and after treatment to evaluate clinical significance.Materials and Methods: The protocol involved an RTX solution (100 ml of 50 nM) instilled in the bladder for 30 minutes. Four men and 6 women 59 to 75 years old were treated. Effects on bladder function were evaluated before and 30 days after treatment by cystometry and Neurometer (Neurotron, Inc., Baltimore, Maryland). Subjective and objective measures included bladder diaries and quality of life before treatment, and 7, 30 and 90 days subsequently.Results: Of the 10 patients 5 noted improvement and 2 of them became dry. The other 5 patients were considered to have stationary symptoms. Mean maximal cystometric capacity SD increased from 229 108 ml at baseline to 271 +/- 99.5 ml at 30 days (p = 0.04). The mean number of daily episodes of urinary incontinence decreased from 3.5 +/- 2.2 to 2.0 +/- 1.6 (p = 0.008) at 7 days, to 1.9 +/- 1.6 (p = 0.018) at 30 days and to 2.5 +/- 1.7 (p = 0.018) at 90 days. Mean current perception threshold values of C and A 8 fibers did not change significantly, from 46.9 +/- 35.2 to 56.4 +/- 32.1 (p = 0.161) and from 66.9 +/- 31.7 to 66.4 +/- 25.2 (p = 0.952), respectively. However, values of C fibers increased in all patients who showed improvement from 46.2 +/- 33.2 to 64.0 +/- 36.8 (p = 0.043).Conclusions: Intravesical RTX improved bladder capacity and leak episodes in patients with idiopathic detrusor overactivity. Intravesical RTX is a promising treatment for this condition.