Bladder pharmacologic therapy

Most patients with UUI are managed nonsurgically with a combination of behavioral modification, pelvic floor exercises, and pharmacologic therapy. Only rarely is surgery applied to the problem of UUI. ° When employed, surgery may involve bladder denervation, implantation of a sacral nerve stimulator, or augmentation (enlargement) cystoplasty. 

Rarely, bladder ontlet obstmction may be caused by a functional obstmction at the level of the bladder neck. Hypertrophy of the smooth mnscle fibers at the level of the bladder neck in men and women may result in obstruction to the flow of nrine. In those patients who fail pharmacologic therapy with a-adrenergic receptor antagonists, endoscopic incision using the cy stoscope is highly effective in treating this very nncommon condition. 

Wientjes MG, Badalament RA, An JL. Use of pharmacologic data and computer simulations to design an efficacy trial of intravesical mitomycin C therapy for superficial bladder cancer. Cancer Chemother Pharmacol 1993,32(4) 255-62. 

Acetylcholine is the neurotransmitter that mediates both volitional and involuntary contractions of the bladder. Bladder smooth muscle cholinergic receptors are mainly of the M2 variety however, M3 receptors are responsible for both emptying contraction of normal micturition and involuntary bladder contractions, which can result in UI. Therefore, most pharmacologic antimuscarinic therapy is anti-M3 based. 

The first compound of the taxanes series, paclitaxel (Taxol), was isolated from the bark of the Western yew tree in 1971. It and its congenic, the semisynthetic docetaxel (Taxotere), exhibit unique pharmacological actions as inhibitors of mitosis, differing from the vinca alkaloids and colchicine derivatives in that they bind to a different site on P-tubulin and promote rather than inhibit microtubule formation. The drugs have a central role in the therapy of ovarian, breast, lung, esophageal, bladder, and head and neck cancers. 

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