Current and future pharmacological treatment for overactive bladder.
OBJECTIVE
Urinary incontinence and overactive bladder are important and common conditions that have received little general medical attention. We reviewed the magnitude and impact of these conditions, and discuss pharmacotherapy as well as new drugs under investigation.


METHODS
The main emphasis of this review is pharmacological therapy for the bladder. We discuss currently available agents, drugs under development and pharmacological targets that would be suitable targets for treating overactive bladder. Drugs such as duloxetine that target not bladder smooth muscle, but rather central nervous system control of the micturition reflex are undergoing clinical trials. We also discuss intravesical therapy and alternative drug delivery methods, such as intravesical capsaicin and botulinum toxin, with special emphasis on approaches to modulate bladder afferent nerve function for preventing overactive bladder.


RESULTS
There are many advantages to advanced drug delivery systems, including long-term therapeutic efficacy, decreased side effects and improved patient compliance. Future speculation such as gene therapy holds great promise for overactive bladder because it is possible to access all genitourinary organs via endoscopy and other minimally invasive techniques that are ideally suited for gene therapy.


CONCLUSIONS
Traditional anticholinergic therapies are limited in their effectiveness. There is great hope for future research regarding voiding dysfunction and urinary incontinence through a focus on afferent nerve intervention for preventing overactive bladder.
Yoshimura
Naoki
N
Department of Urology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Chancellor
Michael B
MB
D000328:Adult; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005544:Forecasting; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013116:Spinal Cord / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics / Q000187:drug effects / Q000502:physiology
D018680:Cholinergic Antagonists