Objectives: To assess the pungency and the desensitizing effects of intravesical resiniferatoxin, an ultrapotent capsaicin analog, in patients with detrusor hyperreflexia.Methods: Fourteen patients with detrusor hyperreflexia were instilled during 30 min, without any form of local anesthesia, with 100 ml (or the bladder capacity if lower than that volume) of 50 or 100 nM resiniferatoxin solutions in 10% alcohol in saline. Patients were evaluated by voiding chart and urodynamic tests (volume to first contraction, maximal cystometric capacity, maximal detrusor pressure, icewater test) at 14, 30, 60, and 90 days and every 3 months thereafterResults: Resiniferatoxin instillation did not evoke pain or temporary worsening of urinary symptoms. Treatment improved or abolished incontinence in 9 out of 12 incontinent patients. Mean urinary frequency decreased from 14.2±6.4 to 10.3±3.2 at 3 months (p = 0.01). At this time point, mean maximal cystometric capacity increased from 182.3±119.8 to 330.0±201.6 ml (p = 0.01) and the ice water test, positive in 13 cases, became negative in 8 of them. Maximal detrusor pressure was not modified by the treatment. The effect was long–lasting, reaching 12 months in 7 cases.Conclusions: The absence of irritative symptoms during bladder instillation of resiniferatoxin and the rapid onset of desensitization make this vanilloid superior to capsaicin for the treatment of detrusor hyperreflexia.

Wein AJ: Neuromuscular dysfunction of the lower urinary tract and its treatment; in Walsh PC, Retik AB, Vaughan ED Wein JA (eds): Campbell’s Urology. Philadelphia, Saunders, 1998, pp 953–989.
de Groat WC, Kawatani M, Hisamitsu T, Cheng CL, Ma CP, Thor K, Steers W, Roppolo JR: Mechanisms underlying the recovery of urinary bladder function following spinal cord injury. J Auton Nerv Syst 1990;30:571–578.
de Groat WD: A neurologic basis for the overactive bladder. Urology 1997;50(suppl 6A): 36–52.
Maggi CA, Barbanti G, Santicioli P, Beneforti P, Misuri D, Meli A, Turini D: Cystometric evidence that capsaicin–sensitive nerves modulate the afferent branch of the micturition reflex in humans. J Urol 1989;142:150–154.
Fowler CA, Beck RO, Gerrard S, Betts CD, Fowler CG: Intravesical capsaicin for treatment of detrusor hyperreflexia. J Neurol Neurosurg Psychiatry 1994;57:169–173.
Geirsson G, Fall M, Sullivan L: Clinical and urodynamic effects of intravesical capsaicin treatment in patients with chronic traumatic spinal detrusor hyperreflexia. J Urol 1995;154: 1825–1829.
Das AS, Chancellor MB, Watanabe T, Sedor J, Rivas DA: Intravesical capsaicin in neurologic impaired patients with detrusor hyperreflexia. J Spinal Cord Med 1996;19:190–193.
Cruz F, Guimarães M, Silva C, Rio ME, Coimbra A, Reis M: Desensitization of bladder sensory fibers by intravesical capsaicin has long–lasting clinical and urodynamic effects in patients with hyperactive or hypersensitive bladder dysfunction. J Urol 1997;157:585– 589.
De Ridder D, Chandiramani V, Dasgupta P, van Poppel H, Baert L, Fowler CJ: Intravesical capsaicin as a treatment for refractory detrusor hyperreflexia: A dual center study with long–term follow–up. J Urol 1997;158:2087–2092.
Wiart L, Joseph PA, Petit H, Dosque JP, de Seze M, Deminiere C, Ferrière JM, Mazaux JM, N’guyen Ph, Barat M: The effects of capsaicin on the neurogenic hyperreflexic detrusor. A double blind placebo controlled study in patients with spinal cord disease. Preliminary results. Spinal Cord 1998;36:95–99.
Szallasi A, Blumberg PM: Resiniferatoxin, a phorbol–related diterpene, acts as an ultrapotent analogue of capsaicin, the irritant constituent of red pepper. Neuroscience 1989;30: 515–520.
Szallasi A, Nilsson S, Hokfelt T, Lundberg JM: Visualizing vanilloid (capsaicin) receptors in pig spinal cord by [3H] resiniferatoxin autoradiography. Brain Res 1994;655:237–240.
Caterina MJ, Schumacher MA, Tominaga M, Rosen TA, Levine JD, Julius D: The capsaicin receptor: A heat–activated ion channel in the pain pathway. Nature 1997;389:816–824.
Maggi CA, Patacchini R, Tramontana M, Amann R, Giuliani S, Santicioli P: Similarities and differences in the action of resiniferatoxin and capsaicin on central and peripheral endings of primary sensory neurons. Neuroscience 1990;37:531–539.
Craft RM, Porreca F: Long–lasting desensitization of bladder afferents following intravesical resiniferatoxin and capsaicin in the rat. Pain 1995;61:317–323.
Oshisuka O, Mattiasson A, Andersson K–E: Urodynamic effects of intravesical resiniferatoxin and capsaicin in conscious rats with and without outflow obstruction. J Urol 1995;154: 611–616.
Cruz F, Avelino A, Coimbra A: Intravesical resiniferatoxin desensitizes bladder sensory fibers in a dose dependent manner. J Urol 1997;157:(suppl):79.
Avelino A, Cruz F, Coimbra A: Intravesical resiniferatoxin desensitizes rat bladder sensory fibres without causing intense noxious excitation. A c–fos study. Eur J Pharamcol 1999;378: 17–22.
Cruz F, Guimarães M, Silva C, Reis M: Suppression of bladder hyperreflexia by intravesical resiniferatoxin. Lancet 1997;350:640–641.
Laird MA, Cervero F: A comparative study of the changes in receptive–field properties of multireceptive and nocireceptive rat dorsal horn neurons following noxious mechanical stimulation. J Neurophysiol 1989;62:854–863.
Chandiramani VA, Peterson T, Duthie GS, Fowler CJ: Urodynamic changes during intravesical instillations of capsaicin. Br J Urol 1996;77:792–797.
Ishizuka O, Igawa Y, Mattiasson A, Andersson K–E: Capsaicin induced bladder hyperactivity in normal conscious rats. J Urol 1994;152: 525–530.
Cruz F, Avelino A, Coimbra A: Intravesical resiniferatoxin temporarily decreases sensory peptides in the mucosa and muscular layer of the rat urinary bladder. Eur Urol 1999;35(suppl 2):96.
Sengupta JN, Gebhart GF: Mechanosensitive afferent fibers in the gastrointestinal and lower urinary tracts; in Gebhart GF (ed): Visceral Pain. Progress in Pain Research and Management 5. Seattle, IASP Press, 1995, pp 75–98.
Acs G, Biro T, Acs P, Modarres S, Blumberg PM: Differential activation and desensitization of sensory neurons by resiniferatoxin. J Neurosci 1997;17:5622–5628.
Cruz F, Avelino A, Coimbra A: Desensitization follows excitation of bladder primary afferents by intravescial capsaicin, as shown by c–fos activation in the rat spinal cord. Pain 1996;64: 553–557.
Lazzeri M, Beneforti P, Turini D: Urodynamic effects of intravesical resiniferatoxin in humans: Preliminary results in stable and unstable detrusor. J Urol 1997;158:2093–2096.
Lazzeri M, Spinelly M, Beneforti P, Zanollo A, Turini D: Intravesical resiniferatoxin for the treatment of detrusor hyperreflexia refractory to capsaicin in patients with chronic spinal cord diseases. Scand J Urol Nephrol 1998;32: 331–334.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.