Abstract
BackgroundWhile Resiniferatoxin (RTX) has been widely used for patients with storage lower urinary tract symptoms (LUTS), its clinical efficiency hasn't yet been well evaluated. A meta-analysis was performed to evaluate the exact roles of intravesical RTX for the treatment of storage LUTS in patients with either interstitial cystitis (IC) or detrusor overactivity (DO).MethodsA meta-analysis of RTX treatment was performed through a comprehensive search of the literature. In total, 2,332 records were initially recruited, 1,907 from Elsevier, 207 from Medline and 218 from the Web of Science. No records were retrieved from the Embase or Cochrane Library. Seven trials with 355 patients were included and one trial was excluded because of the lack of extractable data. The analyses were all performed using RevMan 5.1 and MIX 2.0.ResultsBladder pain was significantly reduced after RTX therapy in patients with either IC or DO. The average decrease of the visual an alogue pain scale was 0.42 after RTX treatment (p = 0.02). The maximum cystometric capacity (MCC) was significantly increased in patients with DO (MCC increase, 53.36 ml, p = 0.006) but not in those with IC (MCC increase, −19.1 ml, p = 0.35). No significant improvement in urinary frequency, nocturia, incontinence or the first involuntary detrusor contraction (FDC) was noted after RTX therapy (p = 0.06, p = 0.52, p = 0.19 and p = 0.41, respectively).ConclusionsRTX could significantly reduce bladder pain in patients with either IC or DO, and increase MCC in patients with DO; however, no significant improvement was observed in frequency, nocturia, incontinence or FDC. Given the limitations in the small patient size and risk of bias in the included trials, great caution should be taken when intravesical RTX is used before a large, multicenter, well-designed random control trial with a long-term follow-up is carried out to further assess the clinical efficacy of RTX in in patients with storage LUTS.
Highlights
Storage lower urinary tract symptoms (LUTS) collectively represent a common condition, including bladder pain, increased urinary frequency, nocturia, urgency and incontinence, which have a major, deleterious, and bothersome impact on quality of life in patients with interstitial cystitis (IC) or detrusor overactivity (DO)
Outcomes of bladder pain Our data showed that bladder pain was significantly reduced after RTX therapy
Since intravesical desensitization of TRPV1 with RTX has been considered as a treatment with great potential for patients with storage LUTS [13,18], we performed this meta-analysis to combine the results from multiple studies and further evaluate the efficacy of intravesical RTX, on bladder pain, urinary frequency, nocturia, incontinence and urodynamic parameters (FDC and maximum cystometric capacity (MCC)), when used for the treatment of storage LUTS in patients with either IC or DO
Summary
Storage lower urinary tract symptoms (LUTS) collectively represent a common condition, including bladder pain, increased urinary frequency, nocturia, urgency and incontinence, which have a major, deleterious, and bothersome impact on quality of life in patients with interstitial cystitis (IC) or detrusor overactivity (DO). The most commonly used oral drugs, such as pentosan polysulfate sodium, anti-inflammatory and anti-cholinergic agents, have limited efficiency and are usually associated with troublesome side effects [2]. It is still an unsolved enigma for physicians to treat LUTS patients effectively [3]. While Resin-iferatoxin (RTX) has been widely used for patients with storage lower urinary tract symptoms (LUTS), its clinical efficiency hasn’t yet been well evaluated. A meta-analysis was performed to evaluate the exact roles of intravesical RTX for the treatment of storage LUTS in patients with either interstitial cystitis (IC) or detrusor overactivity (DO)
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