Pharmacological therapy of female urinary incontinence.

BACKGROUND: Although not a life threatening condition, UI is a common problem in women that produces embarrassing and debilitating symptoms, severely affects the quality of life and represents a significant public health problem. The bladder and urethra in women constitute a functional unit that is controlled by a complex interplay between the central and peripheral cholinergic and noradrenergic nervous systems and local regulatory factors. A substantial part of urethral tone in women is also mediated through the effect of estrogen on urethral mucosal function. Theoretically, detrusor instability can be improved by agents that decrease detrusor contractility and genuine stress incontinence by agents that increase outlet resistance.

OBJECTIVE: To review the use of various drugs in treatment of female urinary incontinence [UI] and present the current evidence-based recommendations.

METHODS: Systematic review of literature.

RESULTS: The strength of evidence for the use of such agents, however, varies from data obtained from pharmacological and physiological experiments to those derived from clinical studies. Hence, the use of some of the currently prescribed drugs for treatment of female UI is founded more on tradition than on evidence based on results from controlled clinical trials. There is also an urgent medical need for a new smooth muscle agent for treating UI in women because current drug therapy of UI is either inadequate or ineffective. Therefore, further clinical experience with drugs that selectively modulate the electrophysiological properties and the intracellular pathways of the smooth muscles of the lower urinary tract in women as therapeutic agents for UI is awaited with interest.