New Pharmacologic and Minimally Invasive Therapies for the Overactive Bladder

Michael Franks, MD, Emmanuel Chartier-Kastler, MD, Michael B. Chancellor, MD

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Abstract and Introduction

There are many new treatment options for the overactive bladder that are discussed in this article, including the recently introduced drugs tolterodine and oxybutynin XL. Other drugs are in development and being assessed, including the novel intravesical therapies capsaicin and resiniferatoxin and the use of intrathecal clonidine for patients with complete spinal cord injury. A minimally invasive technique of sacral nerve stimulation, which can salvage many cases of refractory incontinence, is another treatment option. Finally, an implantable bladder drug delivery system that can deliver a constant therapeutic dose of an anticholinergic drug for 30 days is being developed as well as gene therapy whereby beneficial proteins or cytokines can be delivered into the lower urinary tract. We believe urologists will be treating patients with gene therapy through a cystoscope by 2010.

Urinary incontinence and the overactive bladder (OAB) are becoming a hot topic in the pharmaceutical industry. One reason is that the number of patients with OAB and OAB's staggering potential economic impact are just now becoming recognized. In the United States, among an estimated 17 million men and women who have bladder control problems are many who suffer from OAB, which costs an estimated $26 billion a year to manage.[1] With the aging of the population, the problems associated with OAB will continue to grow.

Interest in OAB has also increased because of improved treatment options. There has been a lull in new treatment options since the introduction of oxybutynin chloride in 1972; however, with the recent introduction of tolterodine (Detrol, Pharmacia & Upjohn) and the once-a-day constant release oxybutynin XL (Ditropan XL, Alza), physicians are now armed with better tools to help patients with OAB.

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