Current Pharmacologic Treatment of Lower Urinary Tract Symptoms

Abstract

Disorders of micturition may be divided into disturbances of the storage function of the bladder and disturbances of the emptying function. The main symptoms of disturbances of storage function are frequency, urgency with or without incontinence often with nocturia and is defined as the overactive bladder syndrome (OABs). Overactivity of the bladder may lead to urgency incontinence and incompetence of the urethral closure mechanism to stress incontinence. There are many drugs available for treating OABs, but their efficacy as judged from controlled clinical trials is often limited and there are few drugs that have an efficacy and adverse effect profile sufficient for approval and clinical use. Currently used generally approved drugs target the cholinergic (muscarinic acetylcholine receptors—antimuscarinics) and adrenergic systems (β3-adrenoceptors—β3-adrenoceptor agonists). Bladder contraction in man is mediated by stimulation of muscarinic receptors, and antimuscarinic drugs have been shown to have effect on OABs; however, treatment is often unsatisfactory due to fading of effect and systemic adverse effects. β3-Adrenoceptor agonists seem to have a similar efficacy as antimuscarinics, but fewer adverse effects. The aim of drug treatment of stress incontinence is to increase outflow resistance. Although there is only a limited possibility of improving the condition with drugs, beneficial effects can be obtained in some patients by use of duloxetine.