Purpose of review: Treatment options for the overactive bladder were recently discussed at the 4th International Consultation on Incontinence (ICI) held in Paris, 5-8 July 2008. This article will overview current thoughts on the pharmacological and clinical basis for the different classes of drugs currently used for the treatment of lower urinary tract symptoms/overactive bladder syndrome/and detrusor overactivity. Individual drugs are not discussed in detail; particular consideration is given to therapeutic aspects of the management of the elderly patient.
Recent findings: An extensive literature review confirms the rationale for using antimuscarinic drugs, and that the currently used drugs are efficacius with an acceptable tolerability and safety. In patients resistant to antimuscarinics, botulinum toxin may be an alternative--the vanilloids resiniferatoxin and capsaicin have very limited use. New therapeutic options with positive proof-of-concept studies, but with limited clinical experience, are beta3 adrenoceptor agonists and phosphodiesterase type 5 inhibitors. Positive signals have been found for other classes of drugs (e.g., gonadotropin-releasing hormone antagonists, neurokinin receptor-1 antagonists), but available information is not sufficient for proper assessment.
Summary: Antimuscarinic drugs remain the first-line treatment of the overactive bladder and a favorable efficacy/tolerability-safety ratio can be confirmed. Promising new alternatives are emerging and future controlled studies will decide their place in the therapeutic arsenal.