Vanilloid receptor and detrusor instability.

Very recently, a membrane receptor (vanilloid receptor type 1 [VR-1]) sensitive to capsaicin or resiniferatoxin (RTX) was identified in small- and medium-sized dorsal root ganglion neurons that give rise to most unmyelinated sensory fibers. After vanilloid binding to VR-1, these neurons remain transiently desensitized; that is, less reactive to natural stimuli. It is this effect of vanilloid substances that is being investigated for its potential therapeutic utility. In the urinary bladder, VR-1-expressing fibers are extremely abundant in the mucosa and in the muscular layer. In the latter, VR-1 fibers are intimately apposed to smooth muscle cells. The demonstration, several years ago, that these fibers were involved in detrusor hyperreflexia of spinal origin and in bladder pain processing, justified the clinical application of intravesical capsaicin or RTX in humans with these bladder diseases. More recently, the experimental and clinical evidence that the same type of bladder sensory fibers were also involved in detrusor instability made a strong case for intravesical RTX assay in patients with idiopathic detrusor instability.