Treatment of overactive bladder: what is on the horizon?

Abstract

There is still a need to develop additional effective and well-tolerated therapies for the treatment of overactive bladder (OAB). The purpose of this review is to discuss alternative therapies for idiopathic OAB that employ a unique mechanism of action or offer a novel application of an existing therapy. We performed a comprehensive literature review to identify alternative therapies and potential future treatments for idiopathic OAB. The use of botulinumtoxin for idiopathic OAB is on the rise and FDA approval will likely be granted in the future. New innovations in neuromodulation hold the promise of less invasive and more patient-controlled therapies. A number of novel medications, such as β-adrenoreceptor agonists, or medications with alternative indications, such as phosphodiesterase inhibitors, have been identified as potential therapies for OAB. In addition, novel drug delivery systems, such as vaginal inserts, are also in development and may provide an attractive mechanism to deliver medications with proven efficacy. While conservative measures such as behavioral modification and pelvic floor exercises remain first-line therapy for OAB, anti-muscarinics are the mainstay of medical treatment. For patients with idiopathic OAB refractory to traditional first-line therapies, a number of promising new treatments are on the horizon.

Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies

“…73 Mirabegron is taken once daily and can be used as a primary treatment or add-on therapy with an antimuscarinic in OAB. 74,75 Tricyclic antidepressants, including imipramine, doxepin, desipramine, and nortriptyline, are frequently used for pain and sleep in the rehabilitation setting. Although they have an anticholinergic and direct muscle relaxant effect on the urinary bladder, they are not Food and Drug Administration approved for OAB or NDO.…”

Effects of Pulsed-radiofrequency Electrical Stimulation on the Rat with Detrusor overactivity

“…The pudendal nerve (PN) is the primary conduit for somatic afferent and efferent nerve axons between the sacral spinal cord and urethra. PN plays an important role to modulate contraction of EUS [2]. Pelvic nerves are the most important pathway for initiating the voiding, the afferent pathway of pelvic nerves consist of small myelinated (Aδ) and unmyelinated (C) axons and transport impulses from the receptors of bladder wall [3,4].…”

Role of Nonenhanced Spiral Computed Tomography Scan in Refractory Irritative Bladder Symptoms

“…This approach helps avoiding unnecessary medications and interventions. There are step by step guidelines for diagnosis and treatment of these symptoms (2). Origins of lower urinary tract symptoms can be urethra, prostate, bladder and uretero-vesical junction (UVJ).…”