Current pharmacotherapy of lower urinary tract symptoms

Lower urinary symptoms (LUTS), including the overactive bladder (OAB) syndrome, can be found in 10–15% of all men and women and often have major effects on quality of life and social functioning. The first line of pharmacological treatment of OAB in women has been and still is antimuscarinic drugs. In men α1-adrenoceptor (AR) antagonists remain the standard treatment of LUTS. However, recent advances in the physiology/pathophysiology of LUTS/OAB, recognizing the functional contribution of the urothelium, the spontaneous myocyte activity during bladder filling, and the diversity of nerve transmitters involved, have sparked interest in novel possibilities to treat these conditions. For example, new, selective α1-AR antagonists (naftopidil, silodosin), β3-AR agonists (mirabegron), phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil), combinations (α1-AR antagonist + antimuscarinic), and drugs with a central mode of action (duloxetine, tramadol) all have positive proof of concept documented in randomized, controlled trials. Which of these therapeutic principles will be developed as clinically useful treatments remains to be established.