Treatment of overactive bladder: what is on the horizon?

Int Urogynecol J (2013) 24:513 DOI 10.1007/s00192-012-1860-6

REVIEW ARTICLE

Treatment of overactive bladder: what is on the horizon?

Alana M. Murphy & Ryan M. Krlin &

Howard B. Goldman

Received: 20 March 2012 /Accepted: 10 June 2012 /Published online: 3 July 2012 # The International Urogynecological Association 2012

Abstract There is still a need to develop additional effective and well-tolerated therapies for the treatment of over-active bladder (OAB). The purpose of this review is to discuss alternative therapies for idiopathic OAB that employ a unique mechanism of action or offer a novel application of an existing therapy. We performed a comprehensive literature review to identify alternative therapies and potential future treatments for idiopathic OAB. The use of botulinumtoxin for idiopathic OAB is on the rise and FDA approval will likely be granted in the future. New innovations in neuromodulation hold the promise of less invasive and more patient-controlled therapies. A number of novel medications, such as -adrenoreceptor agonists, or medications with alternative indications, such as phosphodiesterase inhibitors, have been identified as potential therapies for OAB. In addition, novel drug delivery systems, such as vaginal inserts, are also in development and may provide an attractive mechanism to deliver medications with proven efficacy. While conservative measures such as behavioral modification and pelvic floor exercises remain first-line therapy for OAB, anti-muscarinics are the mainstay of medical treatment. For patients with idiopathic OAB refractory to traditional first-line therapies, a number of promising new treatments are on the horizon.

Keywords Anti-muscarinic . -adrenoreceptor agonists . Neuromodulation . Overactive bladder . Botulinumtoxin

Introduction

Overactive bladder (OAB) is defined by the International Continence Society as urinary urgency that is frequently accompanied by urinary frequency and nocturia, with or without urgency urinary incontinence [1]. OAB is a common condition affecting more than 10% of the global population and it has been repeatedly associated with a negative impact on quality of life [2, 3]. After behavioral modification with the possible addition of pelvic floor exercises, anti-muscarinic medications remain the first-line therapy for OAB. Despite favorable success rates for the reduction of OAB parameters with anti-muscarinics, a significant portion of patients will not be candidates for prolonged anti-muscarinic therapy because of its lack of efficacy, loss of efficacy, intolerance to the side effects or...