Recent approaches to the treatment of urinary incontinence: a survey of patent activity from 1995 to 1998

Abstract

In its broadest sense, urinary incontinence (UI) is defined as involuntary loss of urine to such an extent as to become a hygienic or social concern to the patient [1]. Up to 50% of patients suffering from this disorder do not seek medical attention due to embarrassment or their willingness to accept the condition as a ‘normal’ course of ageing. Thus, incontinence often goes undiagnosed and untreated, and, in serious cases, may exact a staggering toll on the self-esteem and social and psychological outlook of those it affects. UI is usually classified into four types: stress, urge, overflow and functional. The first three types of UI refer to dysfunctions in either urine storage or urine emptying, while the latter occurs in patients with a relatively normal lower urinary tract, but who, nevertheless, suffer from severe cognitive impairment or immobility that precludes normal voiding behaviour. Much of the currently available pharmacological intervention includes the use of antimuscarinics/spasmolytics for the treatment of urinary urgency and sympathomimetics for the treatment of stress incontinence. Corrective measures could also involve behaviour modification, pelvic exercise or surgery. Due to significant, intolerable side-effects and/or limited efficacy associated with the current pharmacological approaches to UI treatment, patient compliance is low, resulting in a considerable unmet medical need for a new generation of more useful compounds. This comprehensive review examines the most recent claims for novel treatments of various forms of UI. Traditional approaches along the lines of novel antimuscarinics or novel formulations of currently used antimuscarinics are well represented. Importantly however, several new classes of agents with fewer side-effects have appeared which, if clinically successful, may represent an exciting new frontier in the treatment of UI.

• bladder instability
• detrusor instability
• hyperreflexia
• stress UI
• urge UI
• urinary incontinence