INTRAVESICAL CAPSAICIN AS A TREATMENT FOR REFRACTORY DETRUSOR HYPERREFLEXIA - A DUAL CENTER STUDY WITH LONG-TERM FOLLOW-UP

Purpose: We described the long-term outcome of intravesical capsaicin instillations in patients with urinary incontinence and compared its e fficacy in 2 similar populations of patients with multiple sclerosis i n a dual center study. Materials and Methods: During 5 years 79 patien ts with intractable urinary incontinence have been treated with intrav esical capsaicin. The majority of patients had spinal cord disease due to multiple sclerosis but 4 were neurologically normal. Cystometry wa s performed before and 4 to 6 weeks after intravesical instillation of 1 to 2 mmol./l. of capsaicin in 30% ethanol in saline. Instillations of vehicle (30% ethanol in saline) alone were carried out in 5 patient s. Results: In patients with phasic detrusor hyperreflexia complete co ntinence was achieved in 44%, satisfactory improvement occurred in 36% and treatment failed in 20%. Clinical benefit from a single instillat ion lasted 3 to 6 months and was repeated in some patients with simila r improvement. Capsaicin was ineffective in patients with poor bladder compliance and in neuro! logically normal patients with sensory urgen cy and detrusor instability. There was no clinical or urodynamic impro vement in patients treated with vehicle alone. There have been no long -term complications. Conclusions: Our study shows that repeated instil lations of intravesical capsaicin are effective in treatment of patien ts with detrusor hyperreflexia due to spinal cord disease and that eff ectiveness of the treatment persists at least 3 to 5 years.