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Le traitement par voie intrathécale des troubles neuropérinéaux

Intrathecal therapy for neurogenic perineal dysfunction

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Pelvi-périnéologie

Résumé

La clonidine injectée par voie intrathécale a été testée chez des patients blessés médullaires intolérants ou résistants au traitement parasympathicolytique. Si l’effet précoce de la clonidine sur les paramètres urodynamiques était satisfaisant, les effets secondaires cardiovasculaires et la survenue d’une tolérance précoce en ont limité l’utilisation en infusion chronique. Le baclofène intrathécal a, quant a` lui, un effet sur le réflexe mictionnel sur le plan théorique, mais peu d’effets en pratique clinique sur l’hyperactivité vésicale de patients souffrant d’une spasticité d’origine spinale. Il peut provoquer par ailleurs une modification de la qualité des érections et une incapacité à l’obtention d’éjaculations par stimulation vibratoire pénienne. L’évaluation de nouvelles cibles pharmacologiques médullaires telles que les récepteurs sérotoninergiques ou dopaminergiques pourraient avoir un intérêt à l’avenir.

Abstract

Intrathecal clonidine was tested for controlling bladder hyperreflexia resistant to parasympathicolytic drugs in spinal cord injured patients. Urodynamic parameters were significantly improved after acute intrathecal bolus of low doses of clonidine. Unfortunately, the chronic intrathecal infusion of clonidine induced cardiovascular side effects and tolerance to the drug. Intrathecal baclofen does not significantly modify neurogenic bladder dysfunction caused by spinal lesion even if theoretically this drug affect the mictional reflex. Moreover, intrathecal baclofen can affect erection quality and may prevent ejaculation induced by penile vibratory stimulation in the same population. Future research might do well to evaluate new therapeutic targets such as serotonergic or dopaminergic receptors.

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Authors and Affiliations

  1. Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, Université de Versailles Saint-Quentin, 104, boulevard Raymond-Poincaré, F-92380, Garches, France

    D. Bensmail, A. -L. Godard & P. Denys

  2. Service d’urologie, hôpital Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie, boulevard de l’hôpital, F-75013, Paris, France

    E. Chartier-Kastler

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  1. D. Bensmail
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  2. E. Chartier-Kastler
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  3. A. -L. Godard
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  4. P. Denys
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Correspondence to D. Bensmail.

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Bensmail, D., Chartier-Kastler, E., Godard, A.L. et al. Le traitement par voie intrathécale des troubles neuropérinéaux. Pelv Perineol 3, 315–318 (2008). https://doi.org/10.1007/s11608-008-0215-8

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  • DOI: https://doi.org/10.1007/s11608-008-0215-8

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