Intravesical oxybutynin: A local anesthetic effect on bladder C afferents
Intravesical oxybutynin: A local anesthetic effect on bladder C afferents
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DOI：
10.1097/01.ju.0000049903.60057.4b
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发表时间：
2003-05-01
影响因子：
6.6
通讯作者：
Wyndaele, JJ
中科院分区：
文献类型：
--
作者：
De Wachter, S;Wyndaele, JJ
目的：膀胱内奥昔布宁用于控制口服奥昔布宁无效或不能耐受的患者的膀胱过度活动。虽然它是临床有效的，膀胱内奥昔布宁的作用方式仍然不清楚。我们测试了膀胱内注射奥昔布宁对大鼠膀胱盆神经单纤维传入的影响。材料和方法：共鉴定了15个单传入膀胱单位。根据传导速度将其分为A型或C型纤维。研究了重复膀胱充盈对这些单位的机械敏感性的影响。然后将奥昔布宁滴入并留在膀胱中15分钟。再次分析单一传入活动后15，60和90 minutes.Results：重复膀胱充盈没有改变神经活动的Δ或C纤维。在15分钟后，奥昔布宁被冲洗出膀胱C纤维传入反应显着减少膀胱内的压力和容量相比，控制填充。60分钟时C纤维部分恢复机械敏感性。90分钟后，敏感性仍然增加，没有达到奥昔布宁前的反应水平。没有显着的变化，注意到在重复膀胱充盈或奥昔布宁intillation.Conclusions：在这项研究中，我们表明，膀胱内奥昔布宁有一个直接的麻醉效果在膀胱壁。它暂时脱敏C纤维传入，这可以解释其在减少膀胱过度活动症状的临床益处。未发现对Δ纤维的可测量影响。
Purpose: Intravesical oxybutynin is used to control bladder overactivity in patients who are refractory to or cannot tolerate oxybutynin given orally. Although it is clinically effective, the mode of action of intravesical oxybutynin remains unclear. We tested the influence of intravesical oxybutynin on single fiber pelvic nerve afferents from the rat bladder.Materials and Methods: A total of 15 single afferent bladder units were identified. Based on conduction velocity they were grouped as Adelta or C fibers. The effect of repeat bladder filling was studied on the mechanosensitive properties of these units. Oxybutynin was than instilled and left in the bladder for 15 minutes. Unitary afferent activity was again analyzed 15, 60 and 90 minutes after the drug was removed.Results: Repeat bladder filling did not change nerve activity in Adelta or C fibers. At 15 minutes after oxybutynin was washed out of the bladder C fiber afferents responded significantly less to intravesical pressure and volume compared with control filling. At 60 minutes C fibers partly regained mechanosensivity. After 90 minutes sensitivity still increased without achieving the response level before oxybutynin. No significant changes were noted in Adelta fibers during repeat bladder filling or after oxybutynin instillation.Conclusions: In this study we showed that intravesical oxybutynin has a direct anesthetic effect within the bladder wall. It temporarily desensitizes C fiber afferents, which could explain its clinical benefits in decreasing symptoms of bladder overactivity. No measurable effect was found on Adelta fibers.