ABSTRACT
PURPOSE OF REVIEW: This review outlines current options for women suffering from both stress urinary incontinence (SUI) and underactive bladder (UAB). This is often a challenging patient population; however, many treatment options are available including behavioral, pharmacologic, and surgical. Therapies can be divided into those specifically targeting either the bladder or the bladder outlet. RECENT FINDINGS: For patients with SUI and UAB, several clinical trials have helped to formulate current guidelines. Also, a number of novel techniques and therapeutic agents are currently under investigation. Current surgical treatments frequently employed for SUI include midurethral slings and urethral bulking agents. In contrast, the current treatments for UAB are limited to either sacral neuromodulation in women with Fowlers syndrome or in the majority, clean intermittent catheterization. Recent studies have investigated the use of adjustable urethral slings and novel modes of neuromodulation with varying degrees of success. SUMMARY: Choosing the best treatment plan for SUI combined with UAB involves a thorough understanding of a patient's preferences and goals. Fortunately, women have many options that can significantly benefit their quality of life.
ABSTRACT
PURPOSE: We investigated the presence of functional Beta1, Beta2 and Beta3-adrenoceptor in urothelium and detrusor muscle of human bladder through in vitro pharmacology of selective Beta3 adrenoceptor agonist solabegron. MATERIALS AND METHODS: Expression of these adrenoceptors in surgically separated human urothelium and detrusor muscle were investigated using RT-PCR. The effects of activating these receptors were studied by determining the relaxation produced by Beta-adrenoceptors agonist in pre-contracted human detrusor strips. RESULTS: The results confirmed the presence of mRNA for Beta1, Beta2 and Beta3-adrenoceptor in both human urothelium and detrusor. In an in vitro functional bladder assay, Solabegron and other agonists for Beta-adrenoceptors such as procaterol and isoproterenol evoked potent concentration-dependent relaxation of isolated human bladder strips with pD2 values of 8.73 +/- 0.19, 5.08 +/- 0.48 and 6.28 +/- 0.54, respectively. CONCLUSIONS: Selective Beta3-adrenoceptor agonist may be a potential new treatment for the overactive bladder OAB syndrome. Existence of Beta3-adrenoceptor mRNA exists in the urothelium in addition to the detrusor muscle suggest multiple site of actions for the Beta3-adrenoceptor in the lower urinary tract.
Subject(s)
Adrenergic beta-3 Receptor Agonists , Adrenergic beta-Agonists/pharmacology , Aniline Compounds/pharmacology , Benzoates/pharmacology , Urinary Bladder/drug effects , Urothelium/drug effects , Adolescent , Adrenergic beta-1 Receptor Agonists , Adrenergic beta-2 Receptor Agonists , Adult , Aged , Biphenyl Compounds , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Muscle, Smooth/drug effects , Receptors, Adrenergic, beta-1/genetics , Receptors, Adrenergic, beta-2/genetics , Receptors, Adrenergic, beta-3/genetics , Reverse Transcriptase Polymerase Chain Reaction , Urinary Bladder/metabolism , Urothelium/metabolism , Young AdultABSTRACT
Purpose: We investigated the presence of functional ß1, ß2 and ß3-adrenoceptor in urothelium and detrusor muscle of human bladder through in vitro pharmacology of selective ß3 adrenoceptor agonist solabegron. Materials and Methods: Expression of these adrenoceptors in surgically separated human urothelium and detrusor muscle were investigated using RT-PCR. The effects of activating these receptors were studied by determining the relaxation produced by ß-adrenoceptors agonist in pre-contracted human detrusor strips. Results: The results confirmed the presence of mRNA for ß1, ß2 and ß3-adrenoceptor in both human urothelium and detrusor. In an in vitro functional bladder assay, Solabegron and other agonists for ß-adrenoceptors such as procaterol and isoproterenol evoked potent concentration-dependent relaxation of isolated human bladder strips with pD2 values of 8.73 ± 0.19, 5.08 ± 0.48 and 6.28 ± 0.54, respectively. Conclusions: Selective ß3-adrenoceptor agonist may be a potential new treatment for the overactive bladder OAB syndrome. Existence of ß3-adrenoceptor mRNA exists in the urothelium in addition to the detrusor muscle suggest multiple site of actions for the ß3-adrenoceptor in the lower urinary tract.