resiniferatoxin and Urinary-Incontinence--Stress

To assess the hypothesis that resiniferatoxin (RTX) can be useful in women with urgency incontinence and idiopathic detrusor overactivity (IDO), we conducted a prospective, double-blind, randomized, placebo-controlled, parallel trial comparing the effects of RTX and placebo.. Fifty-eight patients were randomly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo. Safety and efficacy were evaluated over 4 weeks. The primary efficacy endpoints were voiding symptoms evaluated through the voiding diary. Secondary efficacy endpoint was urodynamic response. Quality of life was measured by the Kings' Health Questionnaire. Although improving trends were seen in both groups after the instillations, no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters. RTX instillations were well tolerated with few and self-limited side-effects.. A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence.

Topics: Administration, Intravesical; Diterpenes; Double-Blind Method; Emotions; Female; Humans; Neurotoxins; Placebos; Quality of Life; Social Behavior; Treatment Outcome; Urinary Bladder, Overactive; Urinary Incontinence, Stress; Urination

Drug treatment for female urinary incontinence requires a thorough knowledge of the differential diagnosis and pathophysiology of incontinence as well as of the pharmacological agents employed. Pharmacotherapy has to be tailored to suit the incontinence subtype and should be carefully balanced according to efficacy and side effects of the drug. Women with urge incontinence require treatment that relaxes or desensitizes the bladder (antimuscarinics, estrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetine), whereas patients with stress incontinence need stimulation and strengthening of the pelvic floor and external sphincter (alpha-mimetics, estrogens, duloxetine). Females with overflow incontinence need reduction of outflow resistance (baclofen, alpha-blockers, intrasphincteric botulinum toxin A) and/or improvement of bladder contractility (parasympathomimetics). If nocturia or nocturnal incontinence are the major complaints, control of diuresis is obtained by administration of the ADH analogue desmopressin. Future developments will help to further optimize the pharmacological therapy for female urinary incontinence.

Topics: Adrenergic alpha-Antagonists; Adrenergic beta-Agonists; Botulinum Toxins, Type A; Deamino Arginine Vasopressin; Diterpenes; Electric Stimulation Therapy; Estrogens; Female; Humans; Muscarinic Antagonists; Muscle Hypertonia; Urinary Incontinence; Urinary Incontinence, Stress; Urodynamics; Vinca Alkaloids