An update on the pharmacotherapy for lower urinary tract dysfunction

Abstract

Introduction: 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.

Areas covered: 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.

Expert opinion: 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.

Keywords:

• bladder outflow obstruction
• iatrogenic obstruction
• overactive bladder
• pharmacotherapy
• stress urinary incontinence
• underactive bladder
• urgency incontinence

Declaration of interest

HB Goldman has been a consultant/speaker for Allergan, Medtronic, Uroplasty and Astellas. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

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