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THE USE OF DIMETHYL SULFOXIDE IN THE

TREATMENT OF GENITOURINARY DISORDERS


Lester Persky
Department of Urology,
The University Hospitals of Cleveland
and
Bruce H . Stewart
Department of Urology,
The Cleveland Clinic Foundation
The recently described medical applications of an old compound, dimethyl
sulfoxide, has excited the interest of both the profession and the public. This
drug, with its remarkable penetrating powers, was used initially as a cellular
and tissue preservative and then had application in more generalized studies
of hyp~thermia.~ The extraordinary faculty of this compound to gain access
rapidly to the circulation through the skin,4 with its described efficacy in the
relief of various inflammatory states of the musculoskeletal system5 and other
6
areas, led to our investigation of its use in assorted acute and subacute
conditions of the genitourinary tract.
The patients selected for study were taken from the private and staff
urological services of the Cleveland Clinic and University Hospitals of Cleve-
land. All patients were informed of the nature of the drug and were told that it
was investigational in character. Their consent was obtained prior to its appli-
cation. Because of the investigational nature of the study, only well-informed,
alert patients were employed. The compound, which has been restricted to
external, topical application only, was applied to the skin over the diseased
area twice daily. Pure solutions of 100% strength were used in some patients;
in others, 50% concentrations were started and increased every few days as
tolerated. Observations were made of the hematopoietic, hepatic, and gas-
trointestinal systems to note any possible adverse, toxic effects. The. area of
application was also monitored for local irritative phenomena.
The disease-states which were studied and their numbers are summarized
in TABLE 1. These include patients with Peyronies disease, interstitial
cystitis, epididymitis, herpes of the genitalia, and other inflammatory and
painful conditions of the genitourinary tract.
Results
Thirteen patients with Peyronies disease were treated. Because of the
fibrosis of the cavernous sheath and septum between the corpora cavernom,
severe penile angulation with erection resulted; and none of these patients
was able to perform satisfactory coitus. In the past, a whole host of drugs
and agents have been advocated with only slight true relief in this condition.
551
552 Annals New Y ork Academy of Sciences
TABLE 1
TOPICAL THERAPY WITH DMSO IN VARIOUS GENITOURINARY DISORDERS

Disease Entity No Pts Treated No R s Improved

Peyronies disease 13 6
Interstitial cystitis 15 2*
Epididymitis 12 7
Herpes progenitalis 5 2
Polycystic kidneys 2 2
Incisional pain, flank 3 3
Vague genital pain 14 1

*Intravesical instillation of definite value in some pts, not responding to


topical therapy .
Surgery is usually attended only by a recurrence of more severe degree, and,
if DMSO is truly effective, it could well institute a significant therapeutic
advance. Of the 13 patients so treated, six were significantly improved and
were able to resume reasonably normal intercourse. One patient had complete
disappearance of the fibrotic plaque, and three others showed definite
evidence of resolution of the fibrosis. The remainder of the subjects were
unaffected. Applications a t the time of this writing had varied from eight to
twelve weeks in length.
Fifteen patients with interstitial cystitis were treated. This disease, also
of unknown origin, effects females largely and produces a characteristic train
of symptoms. These women have extreme frequency, nocturia, and suprapubic
pain which is relieved by voiding. Often the patient can localize the exact
area of vesical disease. At cystoscopy , a characteristic hyperemic mucosal
lesion is noted. These areas blanche with distention and bleed with further
stretching. Submucosal scarring develops, contracts, and further reduces
bladder capacity-all leading to a vicious cycle of increasing pain and fre-
quency. A variety of therapeutic regimens in the past have afforded only
meager success. Many patients require endoscopic treatment under anesthesia
every two or three months for life.
Only two of the 15 patients in this series had significant and lasting
benefit by external application of DMSO; yet these patients have remained
free of symptoms for a t least six months after cessation of therapy. In a small
group of women treated before FDA regulations had restricted the drug to
external application only, dramatic relief of pain was achieved by intravesical
instillation. Fifty cc of 50% DMSO was instilled for 15 minutes, after which
the patient voided and was able to leave the office without distress. With-
drawal of the drug for internal use necessitated the cessation of these observa-
Persky & Stewart: DMSO Treatment of Genitourinary Disorders 553
tions, although the patients often claimed they had obtained significant relief
of symptoms for the first time in years and were extremely anxious to continue
the therapy despite possible risk.
In seven out of twelve men with acute epididymitis there was relief of local
discomfort and pain. In three instances, this was most dramatic with an
almost sudden reversal of discomfort. The swelling and edema attending the
inflammation did not appear to be affected, however, and there did not appear
to be any shortening of the patients course of convalescence. In the treatment
of these patients, there was no discontinuation or interruption of conventional
management, which included chemotherapy, rest, and immobilization and/ or
elevation. The majority of these developed after prostatectomy, although a
few were associated with prostatitis and lower urinary tract infection.
Five patients with herpes of the genitalia were treated by daily applica-
tion. Two of these responded quickly and completely to DMSO, and the
disease was arrested without recurrence. In three others, no apparent benefit
occurred from the use of the drug.
Seventeen patients with vague flank and genital pain were treated with
topical DMSO. Three patients with severe incisional pain in the lumber area
achieved prompt and complete relief of pain after drug application. When
DMSO was applied to nine patients with vague suprapubic pain, no benefit
could be detected. Of five patients with genital pain of obscure origin, only one
seemed to be partially relieved of symptoms. Two patients with typical renal
colic were only slightly relieved by topical application of*DMSOover the area
of pain.
Two patients with polycystic kidneys are interesting. The first patient had
noted concomitant relief of her constant, dull flank pain when applying
DMSO to an area of acute cervical myositis. Therefore, a second patient, who
had polycystic kidney disease and constant flank discomfort, was given the
drug locally over both flank areas. She noted dramatic relief of pain, and, then,
in contradistinction to the first patient, she began using the drug for relief
of joint and arthritic pains which had co-existed in her hands and shoulders.

Discussion
Although these few cases do not constitute an overwhelming group, certain
things can, nevertheless, be concluded. In the first place, no adverse effects
were noted on kidney, liver, gastrointestinal tract, or bone marrow. A few
patients noted rashes in the area of application. These rashes have been ob-
served by other workers and are probably caused by the histamine-liberating
effect of DMSO on the mast cells in the skin. The rash usually disappears
after two or three weeks when the mast cell stores of histamine are depleted. It
is surprising, however, that in only one of the patients in this series applying
DMSO to the genitalia or scrotum was this complication noted. In two of the
patients with interstitial cystitis applying the drug to the lower abdomen, it
554 Annals New Y ork Academy of Sciences
was necessary to discontinue application of 100% solution because of local
irritation, resuming it later on with a less concentrated solution.
Some failures seen in our groups may be a matter of dosage or a result of
application over too brief a period of time. I t is possible that the greatest
use of this compound may be as a vehicle for other drugs. The amazing
property of skin penetration has been described by Stoughton* and has
already been exploited dermatologically .7 We have seen truly remarkable
relief of pain from topical application, and this experience is one shared by
orthopedists in dealing with acute sprains and bursitis. One major drawback to
the indiscriminate use of this agent is the garlic-like odor which is noticeable
on the patients breaths shortly after application. A t times this is offensive to
patients and visitors alike. This inevitable and concomitant side-effect has
made double blind or control studies difficult and very complex.
Our initial experiences with this drug in urology have been interesting
and challenging. There are many other areas that could be explored: e.g.,
renal colic, urethral strictures, and a host of other situations. We hope to
report on these ultimately. As work progresses throughout the world, it is cer-
tain that the exact mechanism of action and true therapeutic worth of this
fascinating substance will come to light.

Summary
DMSO has been used in the treatment of a number of patients with various
genitourinary disorders, including Peyronies disease, interstitial cystitis,
acute epididymitis, vague genitourinary pain syndromes, and polycystic
kidney disease. Although many patients failed to benefit in anyway whatso-
ever, there were some who obtained dramatic and gratifying relief of
symptoms. Further use of the drug in the treatment of these disorders,
particularly when conventional methods of treatment have failed, seems
definitely indicated.

References
1. LOVELOCK, J. E. & M. W . H. BISHOP. 1959. Prevention of freezing damage to living
cells by dimethyl sulfoxide. Nature 183 1394-1395.
8. ASHWOOD-SMITH, J. J. 1961. Preservation of mouse bone marrow at -79C with
dimethyl sulfoxide. Nature 190: 1204-1205.
3. DESHPANDE. P. J., J. FELLMAN & S. W . JACOB. 1962. Studies on viability of hearts
following depression of freezing point. Circulation 26(2): 708.
4. STOUGHTON, R . B. Q W. FRITSCH. 1964. Influence of dimethyl sulfoxide (DMSO)
on human percutaneous absorption. Arch. Derm. 9 0 512.
5. ROSENBAUM, E. E. & S. W. JACOB. 1964. Dimethyl sulfoxide (DMSO) in musculo-
skeletal injuries and inflammations. Northwestern Med. 6 3 227.
6. SCHERBEL, A. L., L. J. MCCORMACK & M. J. POPPO. 1964. Alteration of collagen in
generalized scleroderma after treatment with dimethyl sulfoxide. Cleveland
Clinic. Quart. 90:512.
7. GOLDMAN. L. & K. W. KITZMILLER. 1965. Topical 5-iodo-2-deoxy-uridine in
dimethyl sulfoxide (DMSO). Ohio Med. J. 61: 532.

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