Treatment of overactive bladder symptoms beyond antimuscarinics: current and future therapies

Overactive bladder (OAB) is a common syndrome that affects both men and women. First-line therapies for the management of OAB symptoms consist of antimuscarinic agents and behavioral therapy, ideally used in combination. Although effective in improving OAB symptoms, the use of antimuscarinic therapy may be limited by side effects, contraindications, and insufficient response. Current second-line therapies include sacral nerve stimulation and percutaneous tibial nerve stimulation. These therapies have been shown to be useful in treating OAB symptoms, but are more invasive and time-consuming than medical therapy. Onabotulinum toxin A is currently under investigation for idiopathic OAB, as well as the β-3-adreno-renoreceptor agonists mirabegron and solabegron. The role of these agents, with different mechanisms of action, in the pharmacologic management of OAB remains to be determined, although they appear to be promising alternatives and possible adjuncts to current pharmacologic and behavioral therapy. This article discusses second-line and current and future therapies for the management of OAB symptoms.