title: An update on the pharmacotherapy for lower urinary tract dysfunction.
abstract: BACKGROUND
  The lower urinary tract (LUT) stores and evacuates urine. It is controlled by autonomic, somatic and sensory innervation. Pharmacotherapy has been developed to optimize neural control of the LUT in pathologic states.
  
  
  METHODS
  The bladder can be overactive or underactive. For overactive bladder, medications targeting various receptors include i) antimuscarinics, ii) mixed-action drugs, iii) β-adrenergic receptor agonists and iv) other medications. There is no effective pharmacotherapy for underactive bladder, although medications have been used with limited success, including i) muscarinic receptor agonists, ii) anticholinesterase inhibitors and iii) α-adrenergic receptor antagonists. At the level of the outlet, there can be decreased resistance resulting in stress urinary incontinence (SUI) or increased resistance resulting in bladder outflow obstruction (BOO). The classes of medications for SUI include i) α-adrenergic receptor agonists, ii) β-adrenergic receptor agonists and iii) antidepressants. Medications used to treat BOO include i) α-adrenergic receptor antagonists, ii) 5-α reductase inhibitors, iii) benzodiazepines, iv) baclofen and v) PDE inhibitors.
  
  
  CONCLUSIONS
  Pharmacotherapy for the LUT must be individualized based on degree of bother, medication side-effect profile, concomitant comorbidities, current medication regimen, and insurance coverage. This review describes current medical therapies for the LUT.
authors.affiliation: Montefiore Medical Center, Department of Urology , Bronx, NY USA.
authors.forename: Nitya
authors.initials: N
authors.lastname: Abraham
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D014522:Urethral Diseases / Q000188:drug therapy* / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000503:physiopathology; D014551:Urinary Tract / Q000294:innervation
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D000318:Adrenergic beta-Agonists; D000928:Antidepressive Agents; D018727:Muscarinic Antagonists
keywords: bladder outflow obstruction; iatrogenic obstruction; overactive bladder; pharmacotherapy; stress urinary incontinence; underactive bladder; urgency incontinence