The overactive bladder: review of current pharmacotherapy in adults. Part 1: pathophysiology and anticholinergic therapy.
Overactive bladder is a syndrome characterised by urinary urgency, with or without urge incontinence, and usually with frequency and nocturia. It affects millions of people of all ages worldwide and causes significant morbidity, especially in terms of health-related quality of life. It poses a huge economic burden on health resources. Managing such patients involves a thorough history, physical examination and the use of pertinent investigations before the initiation of treatment. Therapy consists of lifestyle changes, bladder training, anticholinergics, second-line agents such as resiniferatoxin instillation or botulinum toxin injections into the bladder in refractory cases and, finally, in intractable cases, surgery. In the first part of this review of pharmacotherapy for the treatment of this condition, the focus is on the pathophysiological factors potentially involved in overactive bladder and covers the wide range of currently available first-line anticholinergic agents. Treatment algorithms are suggested on the basis of current literature.
Sahai
Arun
A
Urology Department, Guy's Hospital, London, UK.
Khan
Mohammed Shamim
MS
Arya
Manit
M
John
Jason
J
Singh
Rajinder
R
Patel
Hitendra R H
HR
D000279:Administration, Cutaneous; D000283:Administration, Intravesical; D000284:Administration, Oral; D000465:Algorithms; D000818:Animals; D001559:Benzhydryl Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D001561:Benzilates / Q000008:administration & dosage / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D003408:Cresols / Q000008:administration & dosage / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D006801:Humans; D008333:Mandelic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D023421:Models, Animal; D010665:Phenylpropanolamine / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D000068737:Tolterodine Tartrate; D001750:Urinary Bladder, Neurogenic / Q000150:complications; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D001559:Benzhydryl Compounds; D001561:Benzilates; D018680:Cholinergic Antagonists; D003408:Cresols; D003692:Delayed-Action Preparations; D008333:Mandelic Acids; D010665:Phenylpropanolamine; C015586:propiverine; D000068737:Tolterodine Tartrate; C005419:oxybutynin