Medical Treatment of Urinary Incontinence, Urinary Retention, and Overactive Bladder

Abstract

The management of patients with lower urinary tract dysfunction is a challenge. Antimuscarinic drugs represent the first-line treatment in cases of overactive bladder syndrome (OAB). Over the past 10 years, the use of botulinum neurotoxin has revolutionized the treatment of intractable symptoms associated with OAB. All the other drugs used in the treatment of OAB (i.e. α-adrenoceptor (AR) antagonists, β-AR antagonists, prostaglandin synthesis inhibitors, vanilloid agents, cannabinoids) are investigational, and their use is either not recommended or indicated only in specific situations. In the management of stress urinary incontinence, dual serotonin and norepinephrine (noradrenalin) reuptake inhibitors (such as imipramine and duloxetine), bridging the gap between conservative treatment strategies and surgical procedures, would enhance the strength of contraction of the striated urethral sphincter, through a central effect. The pharmacological treatment of chronic urinary retention with and without urinary incontinence (UI) has the purpose of preventing damage to the upper urinary tract by normalizing bladder emptying and endourethral pressures. The drugs employed for this aim are: α-AR antagonists, acetylcholine analogs, cholinesterase inhibitors with their parasympathomimetic effect, endovesical prostaglandins, baclofen, benzodiazepines, and dantrolene. The development of pharmacologic treatment for UI is slow, and the use of some drugs that are currently marketed and prescribed is often based on tradition rather than evidence-based medicine and patient’s expectation.