UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PHARMACOLOGICAL TREATMENT OF OVERACTIVE BLADDER

Eyüp Gökhan Turmuş

Ankara Etlik City Hospital, Department of Gynecology and Obstetrics, Ankara, Türkiye

Turmuş EG. Pharmacological Treatment of Overactive Bladder. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.115-127.

ABSTRACT

Overactive bladder (OAB) is a chronic syndrome characterized by urinary urgency, with or without urge incontinence, frequently accompanied by increased daytime frequency and nocturia, in the absence of identifiable pathology. Its pathogenesis is multifactorial, involving detrusor muscle overactivity, afferent nerve hypersensitivity, and central nervous system dysfunction. The global prevalence of OAB is estimated at nearly 20%, with higher rates among older adults and obese individuals. Beyond its physical manifestations, OAB significantly impairs psychological, emotional, and sexual health and imposes healthcare costs more than double those of unaffected populations, making it a major public health concern. Pharmacological therapy remains the cornerstone of OAB management when lifestyle and behavioral interventions are insufficient. Antimuscarinic agents-including oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine, trospium, imidafenacin, and propiverine-exert their effect by blocking muscarinic receptors and modulating afferent activity, thereby reducing detrusor overactivity. Clinical utility is influenced by receptor subtype selectivity, pharmacokinetics, and ability to cross the blood-brain barrier. Despite proven efficacy, adverse events such as dry mouth, constipation, and cognitive impairment frequently limit adherence, particularly in elderly patients. Extended-release and

transdermal formulations improve tolerability but do not eliminate these challenges. b3-adrenergic receptor agonists, such as mirabegron and vibegron, have emerged as effective alternatives. By enhancing bladder storage capacity during the filling phase without impairing voiding, they provide symptom

relief with a more favorable side effect profile. These agents are particularly suitable for older adults or those at risk of anticholinergic burden, although blood pressure monitoring is recommended due to occasional cardiovascular effects. Additional therapeutic strategies include phosphodiesterase inhibitors, topical estrogen in postmenopausal women, centrally acting agents, and intravesical botulinum toxin injections for refractory cases. In carefully selected populations, these options may enhance symptom control, often in combination with standard therapies. In conclusion, individualized pharmacological management of OAB is essential, balancing efficacy, safety, and patient-specific factors. While antimuscarinics and b3-agonists remain first-line agents, emerging drugs and combination regimens hold

promise for improving long-term outcomes and reducing the clinical and economic burden of OAB.

Keywords: Urinary bladder, overactive; Adrenergic beta-3 receptor agonists; Muscarinic Antagonists; Adverse effects; IncobotulinumtoxinA

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