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Intravesical therapy options for neurogenic detrusor overactivity
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REITZ A; SCHURCH B
SPINAL CORD , 2004, vol. 42, n° 5, p. 267-272 Doc n°: 113617 Localisation : Centre de Réadaptation de Lay St Christophe , en ligne Descripteurs : AE21 - ORIGINE TRAUMATIQUE, AH22 - VESSIE NEUROGENE Url : http://www.nature.com/sc/archive/index.html Neuro-Urology, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. Objectives: This review considers intravesical treatment options of neurogenic detrusor overactivity and discusses the underlying mechanism of action, clinical safety and efficacy, and the future trends. Methods: The available literature was reviewed using medline services. Results: Oral anticholinergic drugs are widely used to treat detrusor overactivity, but they are ineffective in some patients or cause systemic side effects such as blurred vision or dry mouth. As an alternative, topical therapy strategies have been suggested to achieve a profound inhibition of the overactive detrusor and to avoid high systemic drug levels. Currently available intravesical treatment options either act on the afferent arc of the reflex such as local anaesthetics or vanilloids or on the efferent cholinergic transmission to the detrusor muscle such as intravesical oxybutynin or botulinum toxin. Although an established and effective therapy, intravesical oxybutynin is not widely used. Evidence for clinical significance of intravesical atropine and local anaesthetic is missing. Intravesical capsaicin has been shown to improve clinical and urodynamic parameters, but cause pain in some patients. Langue : ANGLAIS |
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