The overactive bladder: review of current pharmacotherapy in adults. Part 2: treatment options in cases refractory to anticholinergics.
In the first part of this review the potential pathophysiological factors involved in the overactive bladder were outlined, and the wide range of first-line anticholinergic pharmacotherapies available for such patients were reviewed. The second part will focus on the intravesical instillation of resiniferatoxin and injections of botulinum toxin into the bladder to treat overactive bladder and detrusor overactivity. Resiniferatoxin has been shown to increase bladder capacity and improve incontinence in patients with neurogenic and non-neurogenic detrusor overactivity. Botulinum toxin has successfully been used to treat neurogenic and idiopathic detrusor overactivity, with improvements observed in bladder capacity, decreases in detrusor pressures on filling and voiding, and increased volumes at first contraction. Further validation is required for both treatments, in the form of large randomised controlled trials, before their use can be considered routine, with particular focus on dosing required.
Urology Department, Guy's Hospital, London, UK.
Arun
A
Sahai
Mohammed Shamim
MS
Khan
Manit
M
Arya
Jason
J
John
Rajinder
R
Singh
Hitendra R H
HR
Patel
D000283:Administration, Intravesical; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004224:Diterpenes / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D015507:Drugs, Investigational / Q000627:therapeutic use; D006801:Humans; D009498:Neurotoxins / Q000008:administration & dosage / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000188:drug therapy; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery
D018680:Cholinergic Antagonists; D004224:Diterpenes; D015507:Drugs, Investigational; D009498:Neurotoxins; C024353:resiniferatoxin; D001905:Botulinum Toxins