β3-Adrenoceptor Agonists for Neurogenic Lower Urinary Tract Dysfunction: Evidence and Clinical Rationale for...

Area of Science:

• Urology
• Pharmacology
• Neuroscience

Background:

• Neurogenic lower urinary tract dysfunction (NLUTD) significantly impacts patients with conditions like spinal cord injury (SCI), multiple sclerosis (MS), and spina bifida.
• Current management strategies aim to optimize bladder storage, prevent upper tract damage, and improve quality of life.

Purpose of the Study:

• To review current evidence on the efficacy and safety of beta3-adrenoceptor agonists in managing NLUTD.
• To evaluate their role in bladder storage optimization and upper tract protection.
• To compare their safety profile with existing therapies.

Main Methods:

• Systematic review of randomized controlled trials, meta-analyses, and observational studies.
• Focus on patient populations including SCI, MS, and spina bifida.
• Assessment of bladder storage parameters, patient-reported outcomes, and cardiovascular/cognitive safety.

Main Results:

• Beta3-adrenoceptor agonists (e.g., Mirabegron, Vibegron) improve cystometric capacity and reduce detrusor pressure.
• Meta-analyses confirm benefits in quality of life and bladder function.
• Cardiovascular safety is reassuring, with no excess risk identified in trials and cohort studies.
• Beta3-agonists show a more favorable cognitive safety profile compared to antimuscarinics.

Conclusions:

• Beta3-adrenoceptor agonists are a safe, effective, and well-tolerated first-line treatment for NLUTD.
• They offer improved bladder safety and continence with reduced systemic side effects.
• A treatment strategy based on beta3-agonists provides a rational, patient-centered approach to NLUTD management.