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Neurochirurgie
Vol 49, N° 2-3  - mai 2003
pp. 395-398
Doi : NCHIR-05-2003-49-2-3C2-0028-3770-101019-ART30
TRAITEMENT DE LA VESSIE HYPERACTIVE PAR LES DROGUES INTRATHÉCALES
 

P. DENYS [1], A. EVEN-SCHNEIDER [1], O. RÉMY-NÉRIS [1], D. BEN SMAÏL [1], E. CHARTIER-KASTLER [1], B. BUSSEL [1]
[1]  Service de Rééducation Neurologique, Hôpital Raymond-Poincaré, Garches.

Tirés à part : P. Denys [1]

[2]  Service de Rééducation Neurologique, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches.

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Chez des patients blessés médullaires intolérant ou résistant au traitement parasympathicolytique, la clonidine intrathécale a été testée. Si l'effet aigu de la clonidine sur les paramètres urodynamiques était satisfaisant, les effets secondaires cardiovasculaires en ont limité l'effet chronique. Par ailleurs, le baclofène intrathécal a peu d'effet sur l'hyperactivité vésicale des patients souffrant d'une spasticité d'origine spinale. Mais il peut entraîner une modification de la qualité des érections et une incapacité d'éjaculations par stimulation vibratoire pénienne.

Abstract
Intrathecal therapy for bladder hyperreflexia

Intrathecal clonidine was tested for the control of bladder hyperreflexia resistant to pararsympathicolytic drugs in spinal cord injured patients. Urodynamic parameters were significantly improved after acute bolus of intrathecal low doses of clonidine. Unfortunately, the chronic intrathecal infusion of clonidine induced cardiovascular side-effects. Intrathecal baclofen did not modified significantly neurogenic bladder dysfunction from spinal lesion. But intrathecal baclofen modified penile erection quality and impaired the ejaculation reflex induced by penile vibratory stimulation in the same population.

Keywords: neurogenic bladder , clonidine , baclofen , erection






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