BERKELEY, CA (UroToday.com) - Intravesical RTX has been used with variable efficacy to treat intractable lower urinary tract symptoms, particularly those associated with neurogenic detrusor overactivity. In a large, multicenter placebo-controlled trial of various doses of a single intravesical instillation of RTX in patients with painful bladder syndrome/interstitial cystitis no response to treatment was noted (J. Urol. 2005;173 :1590-4).

Apostolidis and colleagues from Queen Square, London conducted an open-label study to evaluate the safety and efficacy of a single administration of a relatively high dose of intravesical RTX (100ml of 50nM RTX freshly dissolved in 10% ethanol in saline) with a dwell-time of 30 minutes in patients with urgency and frequency due to increased bladder sensation, and followed results over 6 months. These were patients who largely fall into a gray zone between painful bladder and overactive bladder. Fifteen patients were enrolled with a history of intractable urgency and frequency, with or without urgency incontinence, and presence of increased bladder sensation but no evidence of detrusor overactivity during standard voiding cystometry.

RTX significantly improved maximum cystometric capacity, first desire to void, mean micturition volume, 24 hour frequency, and daytime frequency at all time points. Of 7 patients with bladder pain, only 2 were pain free at 3 months, and at 6 months only 1 of 7 had improved pain. This small, uncontrolled study suggests that the story on RTX is yet to be written, and that larger trials with different dosing and administration frequencies may yet reveal a place for this intravesical therapy in specific voiding dysfunctions.

Apostolidis A, Gonzales GE, Fowler CJ

European Urology, 50(6):1299-1305, 2006

UroToday.com Painful Bladder Syndrome Section

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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