[Drug therapy of bladder dysfunction]

Abstract

Aim: To describe drugs targeting urinary bladder to treat bladder dysfunctions such as OAB, NDO and bladder pain syndrome.

Method: Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM).

Results: Anticholinergics antimuscarinics remain the first-line treatment option for both OAB and NDO. Beta-3 adrenergics emerges as a new therapeutic class for OAB. Post approval safety as well as association with other micturition cycle's drugs need to be evaluated. Phosphodiesterase 5 inhibitors are effective to treat BPH-related LUTS including storage symptoms. Botulinum toxin type A injections within the detrusor are effective and approved to treat NDO in MS and spinal cord injured patients voiding with clean intermittent catheterization. Evaluation of such approach to treat OAB is ongoing. Drug therapy for bladder pain syndrome has limited efficacy including pentosan polyphosphate despite it has a temporary autorisation. There is no drug treatment to restore or improve bladder contraction.

Conclusion: Armamenterium to treat bladder dysfunction has recently increased. Three new therapeutic classes emerged. Careful post approval evaluation is mandatory and study of these drugs' combination is expected. Results should drive changes in bladder dysfunction treatment algorithms.

Keywords: Anticholinergic; Anticholinergiques; Beta-3 adrenergic; Bladder pain syndrome; Botulinum toxin; Bêta-3 agonistes; Incontinence urinaire; Inhibiteur des phosphodiestérases; Neurogenic detrusor overactivity; Overactive bladder; Syndrome clinique d’hyperactivité vésicale; Syndrome de la douleur vésicale; Toxine botulinique; Urinary incontinence.