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Overactive bladder: drug therapy versus nerve stimulation

Nature Clinical Practice Urology volume 2, pages 310–311 (2005)Cite this article

In 2002 the International Continence Society redefined overactive bladder (OAB) as a syndrome of urgency with or without urge incontinence, usually associated with increased frequency of micturition and nocturia. These symptoms are suggestive of DETRUSOR OVERACTIVITY (DO), but can be due to other forms of voiding or urinary dysfunction. These terms can be used if there is no proven infection or other obvious pathology.1 OAB affects approximately 17–20 million people in the US and related costs are estimated to be nearly US$16.4 billion. After behavior modification, there are two primary modes of treatment for OAB: drug therapy and sacral neurostimulation. Each has advantages and disadvantages that the clinical urologist should consider when managing patients with OAB.

Bladder contractions are predominantly under the control of the parasympathetic nervous system. Acetylcholine released from nerve endings activates M3 muscarinic receptors on detrusor smooth-muscle cells and modulates bladder contractility.2,3 A variety of antimuscarinic medications have demonstrated efficacy in suppressing DO, but the various locations of muscarinic receptors in the body combined with the lack of receptor selectivity of most OAB medications contribute to a diverse side-effect profile. The M1 receptor is important in the areas of learning, cognition, and memory, as well as for salivary gland secretion. The expression of M2 receptors in various regions of the heart probably underlies this receptor's effects on cardiac function, such as tachycardia. The M3 receptor is most important in terms of bladder contraction and salivary gland secretion.4,5 Due to a lack of receptor selectivity, antimuscarinic medications for OAB can cause several detrimental side effects. Dry mouth is the most common and bothersome complaint, followed by constipation, blurred vision, dry eyes, drowsiness, and cognitive decline. The ability of some OAB medications to cross the blood–brain barrier results in significant central nervous system side effects that can be harmful in older patients, especially in combination with other medications with anticholinergic properties. Newer antimuscarinic medications for OAB, however, have a lower ability to cross the blood–brain barrier.

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Authors and Affiliations

  1. Department of Urology at Kaiser Permanente Medical Center,

    Apurba S Pathak & Sherif R Aboseif

  2. Director of Neurourology & Reconstructive Surgery,

    Apurba S Pathak & Sherif R Aboseif

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  1. Apurba S Pathak
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  2. Sherif R Aboseif
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Correspondence to Sherif R Aboseif.

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The authors declare no competing financial interests.

Glossary

DETRUSOR OVERACTIVITY (DO)

Involuntary detrusor muscle contractions during the filling phase; may be spontaneous or provoked

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Pathak, A., Aboseif, S. Overactive bladder: drug therapy versus nerve stimulation. Nat Rev Urol 2, 310–311 (2005). https://doi.org/10.1038/ncpuro0227

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