[Medical treatment of disorders of the bladder sphincter]

A lot of drugs can increase or decrease bladder activity or urethral sphincter activity. Some of them are used for treatment of incontinence or chronic retention. In case of severe pollakiuria or urge incontinence secondary to bladder instability, numerous medications can be used: anticholinergic agents, musculotropic relaxants, calcium antagonists, prostaglandin inhibitors, beta-adrenergic agonists, tricyclic antidepressants. Anticholinergic agents are regularly used on first choice. When stress incontinence is present, alpha agonists administered with estrogen and perineal reeducation represent the first stage before surgery. For medical treatment of retention, if there is not outlet obstruction, one can increase detrusor activity with betanechol chloride. In case of outlet obstruction, alpha-blockers or 5 alpha-reductase inhibitors can be used, if there is benign prostatic hyperplasia. Pygeum africanum can be used, but to date there is no clinical study proving its efficacy.