Which drugs are used in the treatment of bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Cholinergic agonists are used in patients with detrusor areflexia; these agents include bethanechol chloride, which may mimic effects of acetylcholine and cause detrusor contractions.

Alpha-adrenergic blocking agents include phenoxybenzamine and prazosin. Phenoxybenzamine is useful for reducing bladder outlet resistance in patients with SCIs, as long as detrusor bladder contractions are present; however, it is not useful in patients with areflexic bladders. Phenoxybenzamine is helpful in patients with detrusor-sphincter dyssynergia.

Anticholinergic agents may help alleviate symptoms in patients with urinary incontinence that is due to uninhibited bladder contractions secondary to suprasacral lesions. This group of drugs includes propantheline bromide, oxybutynin, and tolterodine tartrate, which competitively block acetylcholine receptors at postganglionic autonomic receptor sites, suppressing uninhibited bladder contractions.

Tricyclic antidepressants (TCAs) may (1) have peripheral alpha-adrenergic and central anticholinergic effects, (2) suppress bladder contractions, and (3) enhance bladder neck resistance. Alpha-adrenergic agents are used to enhance bladder neck resistance in patients with stress incontinence or denervation of the bladder neck.

Intravesical agents, such as oxybutynin, have been used. They appear to cause fewer adverse systemic effects; however, the manner in which they are administered is more time-consuming and inconvenient.


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