An update on the pharmacotherapy for lower urinary tract dysfunction

Introduction: The lower urinary tract (LUT) stores and evacuates urine. It is controlled by autonomic, somatic and sensory innervation. Pharmacotherapy has been developed to optimize neural control of the LUT in pathologic states. Areas covered: The bladder can be overactive or underactive. For overactive bladder, medications targeting various receptors include i) antimuscarinics, ii) mixed-action drugs, iii) beta-adrenergic receptor agonists and iv) other medications. There is no effective pharmacotherapy for underactive bladder, although medications have been used with limited success, including i) muscarinic receptor agonists, ii) anticholinesterase inhibitors and iii) alpha-adrenergic receptor antagonists. At the level of the outlet, there can be decreased resistance resulting in stress urinary incontinence (SUI) or increased resistance resulting in bladder outflow obstruction (BOO). The classes of medications for SUI include i) a-adrenergic receptor agonists, ii) beta-adrenergic receptor agonists and iii) antidepressants. Medications used to treat BOO include i) alpha-adrenergic receptor antagonists, ii) 5-alpha reductase inhibitors, iii) benzodiazepines, iv) baclofen and v) PDE inhibitors. Expert opinion: Pharmacotherapy for the LUT must be individualized based on degree of bother, medication side-effect profile, concomitant comorbidities, current medication regimen, and insurance coverage. This review describes current medical therapies for the LUT.