Update on the Pharmacologic Management of Overactive Bladder: The Present and the Future

Pamela Ellsworth; Eileen Kirshenbaum

Disclosures

Urol Nurs. 2010;30(1):29-39. 

In This Article

Abstract and Introduction

Abstract

Overactive bladder (OAB) is a common condition, affecting approximately 17% of females and males 40 years of age and older. Historically, oxybutynin was the only medication approved for use in the management of OAB. Over the past decade, several new antimuscarinics have been approved for the treatment of OAB. Although all are deemed to be effective in improving the bothersome symptoms of OAB, they differ in their molecular properties, metabolism, and tolerability/side effect profile. A greater understanding of the pathophysiology of OAB has led to approved and investigative therapies to treat refractory OAB, such as neuromodulation and intravesical injection of Botulinum toxin, respectively. A variety of pharmacologic agents are in clinical trials for OAB that target different components of bladder function, such as the urothelium, the afferent sensory nerve pathways, and the central nervous system. It is the intent of this article to highlight these aspects of OAB management.
Objectives
1. Define overactive bladder.
2. Explain the impact of overactive bladder on quality of life.
3. Discuss the management of overactive bladder, including behavioral and pharmacologic therapies.
4. List adverse effects of pharmacologic therapies.
5. Discuss future pharmacologic therapies.

Introduction

Overactive bladder (OAB) is a symptom syndrome characterized by the presence of urgency, with or without urgency urinary incontinence (UI), usually with frequency and nocturia. These symptom combinations are suggestive of urodynamically demonstrable detrusor overactivity but can be related to other forms of urethrovesical dysfunction. The symptoms of OAB are storage phase symptoms (Abrams et al., 2002). The International Continence Society (ICS) classifies OAB as a syndrome for which no precise cause has been identified (idiopathic), with conditions that may cause or mimic OAB ruled out by diagnostic evaluation (Abrams et al., 2002; Ouslander, 2004; van Kerrebroeck et al., 2002). Individuals with neurologic diseases, such as multiple sclerosis, spinal cord injury, and myelodysplasia, may have neurogenic OAB but would not be considered to have idiopathic OAB; their management will not be discussed in this article.

Urgency, the cardinal symptom of OAB, is the complaint of a sudden compelling desire to pass urine, which is difficult to defer. Incontinence associated with urgency is defined as urgency (urge) urinary incontinence (UUI). Urinary frequency is defined as eight or more micturitions per day, and nocturia is the complaint that the individual has to wake at night one or more times to void (Abrams et al., 2002).

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