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Pharmacological Therapy for Urinary Incontinence

Article information

J Korean Med Assoc. 2007;50(11):1025-1036
Publication date (electronic) : 2007 November 30
doi : https://doi.org/10.5124/jkma.2007.50.11.1025
Kyu-Sung Lee, MD, Young-Suk Lee, MD
Department of Urology, Sungkyunkwan University School of Medicine, Korea. ksleedr@skku.edu, ysuro.lee@samsung.com

Abstract

Urinary incontinence is an important lower urinary tract symptom that negatively affects the quality of life. Urgency incontinence (UI) is urine loss accompanied by urgency, which is the chief complaint of overactive bladder (OAB) syndrome. OAB is defined as urgency, with or without UI, usually with frequency and nocturia. In contrast, stress urinary incontinence (SUI) involves involuntary urine leakage caused by a sudden increase in abdominal pressure. Treatment for urinary incontinence depends on the type of incontinence, the severity, and the underlying causes. Treatment options fall into four broad categories: lifestyle intervention, bladder retraining and/or pelvic floor muscle training, pharmacotherapy, and surgery. Pharmacotherapy is often the first-line therapy for OAB/UI, either alone or as an adjunct to various nonpharmacological therapies. Effectiveness of anticholinergic drugs for OAB/UI has been assessed in various observational and randomized controlled trials. Despite their side effects, anticholinergics are the first-line agents for UI. Tricyclic antidepressants have complex pharmacological actions such as anticholinergic, alpha adrenergic, antihistaminic, and local anesthetic properties. Recently approved anticholinergics, solifenacin and darifenacin, are selective M3 antagonists that may have tolerable side effects. Transdermal oxybutynin may offer comparable efficacy with oral formulation but lower side effects. In the absence of an effective and well tolerated drug for SUI, pharmacological therapy for this condition has remained in the off-label prescription of some products, particularly estrogens and α-adrenergic agonists. Duloxetine is the drug of choice specifically aimed at SUI. This article outlines the current state and future development in pharmacological therapy for urinary incontinence.

Keywords: Urinary incontinence; Stress urinary incontinence; Urgency incontinence; Pharmacotherapy

References

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Article information Continued

Copyright © 2007 Korean Medical Association

Figure 1

Figure 1

Prevalence (%) of urinary incontinence by age in female.

Figure 2

Figure 2

Initial management of urinary incontinence in men (3rd International Consultation on Incontinence, Monaco, 2004).

Figure 3

Figure 3

Initial management of urinary incontinence in women (3rd International Consultation on Incontinence, Monaco, 2004).

Figure 4

Figure 4

Bladder Effects of Antimuscarinics.

By inhibiting the effects of acetylcholine, generated from non-nervous sources (urothelium) or leaking from cholinergic nerves during the filling phase, antimuscarinics may inhibit detrusor overactivity and urgency.

Table 1

The standardization of terminology in lower urinary tract function (1)

Table 1

Table 2

Causes of overactive bladder

Table 2

Table 3

Condition-specific treatments for incontinence

Table 3

*With or without intermittent self-catheterization.

†These treatments must be considered investigational and are "off label" in most countries.

Table 4

Drugs used in the treatment of detrusor overactivity Assessments according to the Oxford system (modified)

Table 4

*intrathecal, **intravesical, ***bladder wall, ****nocturia

Table 5

Drugs used in the treatment of stress urinary incontinence Assessments according to the Oxford system (modified)

Table 5