Insight into New Potential Targets for the Treatment of Overactive Bladder and Detrusor Overactivity

Abstract

Although overactive bladder (OAB) and detrusor overactivity (DO) are not synonyms, they share therapeutic options and partially underlying physiopathological mechanisms. The aim of this overview is to give insight into new potential targets for the treatment of OAB and DO. A narrative review was done in order to reach this goal. Ageing, pelvic floor disorders, hypersensitivity disorders, morphologic bladder changes, neurological diseases, local inflammations, infections, tumors and bladder outlet obstruction may alter the normal voluntary control of micturition, leading to OAB and DO. The main aim of pharmacotherapy is to restore normal control of micturition, inhibiting the emerging pathological involuntary reflex mechanism. Therapeutic targets can be found at the levels of the urothelium, detrusor muscles, autonomic and afferent pathways, spinal cord and brain. Increased expression and/or sensitivity of urothelial-sensory molecules that lead to afferent sensitization have been documented as a possible pathogenesis of OAB. Targeting afferent pathways and/or bladder smooth muscles by modulating activity of ligand receptors and ion channels could be effective to suppress OAB.

Botulinum Toxin-A Injections for Idiopathic Overactive Bladder: A Systematic Review and Meta-Analysis

“…However, many patients do not respond to these medications or have significant side effects causing discontinuation [2]. Injection of botulinum toxin-A is emerging as an effective treatment for patients in whom conservative measures and anticholinergic treatment have failed [25]. However, there are still many questions surrounding its use, and the purpose of this review was to evaluate the current literature regarding its efficacy, safety, optimal dose and injection technique.…”

Neurological aspects of urinary incontinence in the elderly

“…В настоящее время антихолинергические средства рассматриваются как препараты первого выбора при ле-чении гиперактивности мочевого пузыря [10]. Механизм их действия заключается в блокаде постсинаптических мускариновых холинорецепторов (М2 и М3) детрузора мо-чевого пузыря.…”

“…Безо-пасность и эффективность этих препаратов доказаны в ран-домизированных плацебоконтролируемых мультицентро-вых исследованиях. В настоящее время накоплен большой опыт их применения, и они расцениваются как препараты первой линии при гиперактивности мочевого пузыря [10].…”

Urinary Bladder-Relaxant Effect of Kurarinone Depending on Potentiation of Large-Conductance Ca2+-Activated K+ Channels

“…OAB is a syndrome characterized by the presence of urinary urgency, usually with increased daytime or night-time frequency (reviewed in Cerruto et al, 2012). OAB affects about 17% of the Western world population, both men and women, and its frequency increases with age (Coyne et al, 2013).…”