Pharmacologic management of urinary incontinence in the female

Pharmacotherapy combined with behavioral therapy is often used for the initial therapy of urinary incontinence (UI) in the female. Although there are multiple central and peripheral sites and mechanisms that can potentially influence bladder and urethral function, the pharmacological manipulation of only a select few are clinically useful. The problems are: 1) how to affect bladder function without interfering with the function of other organ systems (uroselectivity); and, 2) how to eliminate UI without disturbing normal micturition. Multiple categories of drug therapies are potentially useful to treat UI. It is clear that the ideal agent for this indication has not yet been identified. Although significant improvement can be seen with several different agents for the treatment of various types of incontinence, complete cure is rarely seen with pharmacological therapy of UI. However, several new pharmacologic treatments including some with novel approaches to drug delivery and/or mechanisms of action have emerged in clinical development over the last few years. In initial studies, some of the agents appear to compare favorably to existing therapies. Whether these promising results will hold up when subjected to large scale, well controlled clinical trials is unclear.