Treatment of the overactive bladder: where we stand in 2003

The understanding and management of overactive bladder (OAB) continue to evolve. However, argument persists as to the exact incidence of the disease and the underlying pathophysiology of the symptom complex. Individual differences in symptomatic impact and, more importantly, personal coping partially account for the disparity noted among demographic estimates currently extant. Likewise, the underlying pathophysiology that leads to overt OAB syndrome is, as yet, incompletely characterized. Muscarinic receptor behavior provides partial explanation, but other complex underlying receptor and neurotransmitter interactions probably are also a component of the presentation. Current state-of-the-art therapy relies on an exclusionary diagnosis prior to the inception of therapy. Ideally, optimal therapy involves behavioral and pharmacologic interventions combined to maximize therapeutic results. Antimuscarinic therapy provides only a degree of relief from the bothersome symptoms of OAB. As yet, few options exist for patients who have previously failed oral antimuscarinic intervention. Herein, the evolving OAB landscape will be considered as it currently stands in 2003. The current lack of optimal symptom control will most assuredly lead to the development of new pathways for OAB treatment.