What is the role of intravesical pharmacotherapy in urinary incontinence treatment?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Intravesical instillation of oxybutynin chloride has been used in patients who are nonresponsive to oral oxybutynin or have severe adverse effects from it. Intravesical oxybutynin has proved effective for treatment of neurogenic bladder dysfunction, although the effects are often transient.. Honda et al reported that intravesical oxybutynin chloride solution supplemented with hydroxypropylcellulose (HPC), a mucosal adhesive substance, provided long-term improvement in bladder compliance in three of four children (ages 1 to 3 years) with neurogenic bladder. [86]

In older patients, intravesical oxybutynin can be self-administered following clean catheterization and has been shown to be safe and efficacious. Studies have shown that tissue and plasma concentration of the drug are higher after intravesical administration than after oral administration. [87] Despite higher plasma levels, adverse effects appear to be minimal. This finding suggests that a hepatic metabolite may be responsible for many of the adverse effects observed after oral administration.

Intravesical capsaicin, the main pungent ingredient of hot peppers, has shown benefit for the treatment of detrusor overactivity and neurogenic detrusor overactivity. [88, 89]  Similarly, resiniferatoxin, a naturally occurring pungent substance from the Euphorbia resinifera plant that has very potent capsaicinlike activity, has been used successfully to treat detrusor overactivity and neurogenic detrusor overactivity. However, intravesical capsaicin has not been approved for use in neurogenic detrusor overactivity, and resiniferatoxin was found to adhere to the plastic bags it was dispensed in; both agents have largely been superseded by onabotulinumtoxinA. [90]


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