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Les thérapies intravésicales en neuro-urologie

Intravesical drugs in neurourology

  • Mise Au Point / Update
  • Published:
Pelvi-périnéologie

Résumé

L’administration intravésicale d’agent thérapeutique permet de délivrer in situ des principes actifs à forte dose en limitant l’occurrence d’effets secondaires systémiques. Le fréquent recours aux cathétérismes urétraux pour la gestion et le suivi de l’appareil urinaire chez les patients neurologiques favorise la faisabilité de cette voie d’administration dans cette population. De nombreuses molécules, affectant le versant afférent ou efférent du réflexe mictionnel, ont été proposées pour réduire l’hyperactivité du détrusor ou favoriser sa contraction chez des patients réfractaires aux thérapies orales de première ligne. Cependant, en dépit du profil d’efficacité et de tolérance satisfaisant de certains agents, l’accès à ces thérapeutiques est limité par leur absence de conditionnement commercialisé pour administration intravésicale et/ou leur courte durée d’efficacité, ne laissant aux thérapies intravésicales qu’une place marginale et sous-exploitées dans l’arsenal thérapeutique des troubles vésicosphinctériens neurogènes.

Abstract

Intravesical instillation therapy is an effective method of introducing high concentrations of pharmacological agents into bladder tissue without causing significant systemic side effects. Urethral catheterization is standard treatment in bladder management in neurogenic patients, making intravesical treatment more feasible in this population. Several therapeutic agents, which act on the afferent and efferent pathways of the micturition reflex, have been proposed as second-line treatments for hyperactive or underactive detrusor muscles. Despite the wide interest in a number of these agents, their use is limited because of the lack of commercially available solutions and the short duration of their therapeutic effects, which have led to underestimating their promise.

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Authors and Affiliations

  1. Service de médecine physique et de réadaptation, unité d’évaluation et de traitement du handicap urinaire, CHU Pellegrin, F-33076, Bordeaux cedex, France

    M. de Sèze, M. P. de Sèze, L. Wiart, E. Shao & P. -A. Joseph

  2. Équipe de recherche handicap et système nerveux EA 4136, université Victor-Segalen-Bordeaux-II, F-33076, Bordeaux cedex, France

    M. de Sèze, M. P. de Sèze & P. -A. Joseph

  3. Departement de pharmacologie clinique, CHU Pellegrin, université Victor-Segalen-Bordeaux-II, F-33076, Bordeaux cedex, France

    S. Blazejewski

  4. Pharmacie du CHU Pellegrin, F-33076, Bordeaux cedex, France

    J. -P. Dosque

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  1. M. de Sèze
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  2. M. P. de Sèze
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  3. L. Wiart
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  4. E. Shao
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  7. P. -A. Joseph
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Correspondence to M. de Sèze.

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de Sèze, M., de Sèze, M.P., Wiart, L. et al. Les thérapies intravésicales en neuro-urologie. Pelv Perineol 2, 318–325 (2007). https://doi.org/10.1007/s11608-007-0158-5

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  • DOI: https://doi.org/10.1007/s11608-007-0158-5

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