[Urinary incontinence: anticholinergic treatment]

Author(s): Jimenez Cidre MA

Affiliation(s): Servicio de Urologia, Hospital Clinico San Carlos, Madrid. mjcidre00@hotmail.com

Publication date & source: 2004-10, Rev Med Univ Navarra., 48(4):37-42.

Publication type: Review

The bladder and urethra are a functional unit controlled and coordinated by the central and peripheral nervous systems. Voluntary or involuntary contraction of the Detrusor muscle depends mainly on muscarinic receptor stimulation by Acetylcholine, which is released from parasympathetic terminals. This receptors are the antimuscarinic (anticholinergic) drug target. Anticholinergic drugs are the first line of treatment for overactive bladder. They have been widely investigated and have shown superior efficacy to placebo in numerous studies. Their effects on bladder function result in an increase of the capacity at which involuntary detrusor contractions are produced, a decrease in its amplitude and an increase in bladder capacity. The purpose of this Literature Review is to provide an up-to-date overview of the current situation of this form of treatment (Oxybutinin, Long Acting Tolterodine, Trospium Chloride) and the main developments in this area. Some of these drugs are already commercially available in Spain (Long Acting Tolterodine), some may appear soon (Extended Release Oxybutinin, Transdermal Oxybutinin), and others are available for specific cases (Intravesical Oxybutinin). Other drugs, which are theoretically more uroselective (Darifenacin or Solifenacin), are not yet freely available on the open market, while yet others are already in use in other countries (Propioverine). Finally I would like to mention the increasing use of Botulinum Toxin detrusor injection for bladder hyperactivity that fails to respond to conservative treatments.