Chapter 6. Urinary incontinence: Neuropharmacological approaches (original) (raw)

Annual Reports in Medicinal Chemistry, 2003

Abstract

Publisher Summary This chapter discusses neuropharmacological approaches to urinary incontinence (UI). UI occurs when the lower urinary tract does not store urine properly and there is an involuntary loss of urine. There are three types of UI: urge, stress, and mixed. Urge is considered to be due to an overactive bladder, while stress UI is considered to be due to decreased urethral outlet resistance. In urge incontinence, the reformulations of oxybutynin and other muscarinic cholinergic receptor antagonists continue to dominate the market and late stage clinical development programs. Enterprising clinicians have taken matters into their own hands and applied off label-use of various toxins as they try to find remedies for their patients, but safe, effective, and convenient therapy is needed to compliment the anticholinergics. The chapter describes the neural reflex pathways that control urine storage and micturition and describes pharmacological targets and drug discovery strategies within the context of these reflexes. It also elaborates the function and dysfunction of the lower urinary tract and discusses the reflex control of the lower urinary tract, along with the sites of drug action for the inhibition of micturition reflexes.

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