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Detrusor Underactivity Model in Rats by Conus Medullaris Transection
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Published on: August 28, 2020

Prospective pharmacologic therapies for the overactive bladder.

Karl-Erik Andersson1

  • 1Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA.

Therapeutic Advances in Urology
|July 27, 2011
PubMed
Summary

New treatments for lower urinary tract symptoms (LUTS), overactive bladder (OAB), and detrusor overactivity (DO) are needed due to antimuscarinic side effects. Several novel drug classes show promise in clinical trials, offering potential alternatives.

Keywords:
detrusor overactivitydrug treatmentincontinence

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Area of Science:

  • Urology
  • Pharmacology
  • Neuroscience

Background:

  • Lower urinary tract symptoms (LUTS), overactive bladder syndrome (OAB), and detrusor overactivity (DO) significantly impair quality of life.
  • Current first-line antimuscarinic treatments face challenges with adverse effects and long-term compliance.
  • Emerging understanding of urothelial function, myocyte activity, and neurotransmitters opens new therapeutic avenues.

Purpose of the Study:

  • To review novel therapeutic strategies for LUTS/OAB/DO beyond traditional antimuscarinics.
  • To evaluate the documented efficacy of emerging drug classes through randomized controlled trials (RCTs).
  • To explore potential peripheral and central modulation targets for LUTS/OAB/DO.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) for novel LUTS/OAB/DO treatments.
  • Analysis of drug classes including beta-3 adrenergic receptor (β(3)-AR) agonists, phosphodiesterase 5 (PDE 5) inhibitors, vitamin D analogs, combination therapies, and centrally acting agents.
  • Assessment of efficacy data from published RCTs.

Main Results:

  • Beta-3 adrenergic receptor agonists (e.g., YM178) demonstrate efficacy.
  • PDE 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil) show effectiveness.
  • Vitamin D analogs (e.g., elocalcitol), combination therapies (e.g., α(1)-AR antagonist + antimuscarinic), and centrally acting drugs (e.g., tramadol, aprepitant) also have RCT-documented efficacy.

Conclusions:

  • Several novel therapeutic principles show documented efficacy in RCTs for LUTS/OAB/DO.
  • These include β(3)-AR agonists, PDE 5 inhibitors, vitamin D analogs, combination therapies, and centrally acting agents.
  • Further development is required to establish which of these will become clinically useful treatments for LUTS/OAB/DO.