Pharmacological treatment of overactive bladder: report from the International Consultation on Incontinence.
OBJECTIVE
Treatment options for the overactive bladder were recently discussed at the 4th International Consultation on Incontinence (ICI) held in Paris, 5-8 July 2008. This article will overview current thoughts on the pharmacological and clinical basis for the different classes of drugs currently used for the treatment of lower urinary tract symptoms/overactive bladder syndrome/and detrusor overactivity. Individual drugs are not discussed in detail; particular consideration is given to therapeutic aspects of the management of the elderly patient.


RESULTS
An extensive literature review confirms the rationale for using antimuscarinic drugs, and that the currently used drugs are efficacius with an acceptable tolerability and safety. In patients resistant to antimuscarinics, botulinum toxin may be an alternative--the vanilloids resiniferatoxin and capsaicin have very limited use. New therapeutic options with positive proof-of-concept studies, but with limited clinical experience, are beta3 adrenoceptor agonists and phosphodiesterase type 5 inhibitors. Positive signals have been found for other classes of drugs (e.g., gonadotropin-releasing hormone antagonists, neurokinin receptor-1 antagonists), but available information is not sufficient for proper assessment.


CONCLUSIONS
Antimuscarinic drugs remain the first-line treatment of the overactive bladder and a favorable efficacy/tolerability-safety ratio can be confirmed. Promising new alternatives are emerging and future controlled studies will decide their place in the therapeutic arsenal.
Andersson
Karl-Erik
KE
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina 27157, USA. Karl-Erik.Andersson@med.lu.se
Chapple
Christopher R
CR
Cardozo
Linda
L
Cruz
Francisco
F
Hashim
Hashim
H
Michel
Martin C
MC
Tannenbaum
Cara
C
Wein
Alan J
AJ
D000322:Adrenergic Agonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D005602:France; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
D000322:Adrenergic Agonists; D000928:Antidepressive Agents; D018727:Muscarinic Antagonists; D010726:Phosphodiesterase Inhibitors