International Urogynecology Journal

, Volume 19, Issue 4, pp 583–598 | Cite as

Emerging pharmacological targets in overactive bladder therapy: experimental and clinical evidences

  • Emilio SaccoEmail author
  • Francesco Pinto
  • Pierfrancesco Bassi
Review Article


Antimuscarinics are the mainstay of the medical therapy for overactive bladder, but their side effects and often modest success have prompted studies on novel pharmacological approaches. In this paper, we give a systematic literature review of peer-reviewed papers on the subject. Effective nonantimuscarinic treatments are currently scarce, but many new promising compounds are emerging, which target key molecular pathways involved in micturition control. The most promising potential therapeutic targets include: nervous GABAergic, glycinergic, dopaminergic, and serotonergic systems; b-adrenoceptors and cAMP metabolism; nonadrenergic–noncholinergic mechanisms such as purinergic and neuropeptidergic systems; vanilloid receptors; bladder afferent nerves; nonneuronal bladder signaling systems including urothelium and interstitial cells; prostanoids; Rho-kinase; and different subtypes of potassium and calcium channels. Despite the enormous amount of new biologic insight, very few drugs with mechanism of action other than antimuscarinics have passed as yet the proof-of-concept stage. Further preclinical and clinical studies are urgently needed in this rapidly moving field.


Bladder Detrusor overactivity Pharmacological targets Urinary incontinence 









adenosine 5′-triphosphate


bladder outlet obstruction


benign prostate hyperplasia


botulinum toxin


3′-5′-cyclic adenosine monophosphate


central nervous system




detrusor overactivity




gamma-aminobutyric acid


GABA transporter


human bladder smooth muscle










International Continence Society


interstitial cells


idiopathic detrusor overactivity


potassium channel opener


nonadrenergic noncholinergic


neurogenic detrusor overactivity




nonsteroidal antiinflammatory drugs


overactive bladder








ryanodine receptor




substance P


selective serotonin reuptake inhibitors




transient receptor potential vanilloid 1




voltage-dependent L-type Ca2+ channel


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Copyright information

© International Urogynecology Journal 2007

Authors and Affiliations

  • Emilio Sacco
    • 1
    • 2
    Email author
  • Francesco Pinto
    • 1
  • Pierfrancesco Bassi
    • 1
  1. 1.Department of Urology, Gemelli HospitalCatholic University Medical SchoolRomeItaly
  2. 2.UrologiaPoliclinico GemelliRomeItaly

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