Chancellor M B
Rev Urol. 2001;3 Suppl 1(Suppl 1):S27-34.
Anticholinergic drugs act on efferent nerves to counteract overactive bladder (OAB) after it occurs. To prevent the occurrence of OAB, therapies should be directed at blocking the afferent nerves that control the bladder. Tachykinin-receptor antagonists hold great promise in this regard, since they can be administered orally and do not increase the risk of urinary retention that occurs with anticholinergics. Advanced drug delivery systems, such as controlled-release oral oxybutynin (oxybutynin-XL) can reduce the incidence of anticholinergic side effects. In a similar manner intravesical therapy for OAB is site specific, and thus also reduces the occurrence of adverse events. Moreover, the difficulties of intravesical therapy may now be overcome with advanced delivery techniques such as an implantable, long-acting drug-delivery pump. Another intravesical therapy that has met with great acceptance and success is the administration of chili pepper extracts, especially resiniferitoxin, which may be effective for up to 3 months with one application. Finally, gene therapy holds great promise for OAB, because it is possible to access all of the genitourinary organs via endoscopy and other minimally invasive techniques that are ideally suited for gene therapy.
抗胆碱能药物作用于传出神经，在膀胱过度活动症（OAB）发生后对抗其症状。为预防OAB的发生，治疗应针对阻断控制膀胱的传入神经。速激肽受体拮抗剂在这方面很有前景，因为它们可以口服，且不会增加抗胆碱能药物所致的尿潴留风险。先进的药物递送系统，如控释口服奥昔布宁（奥昔布宁长效制剂），可以降低抗胆碱能副作用的发生率。以类似方式，OAB的膀胱内治疗具有部位特异性，因此也能减少不良事件的发生。此外，现在可以通过先进的递送技术，如植入式长效药物递送泵，克服膀胱内治疗的困难。另一种获得广泛认可并取得成功的膀胱内治疗方法是施用辣椒提取物，尤其是树脂毒素，一次应用可能有效长达3个月。最后，基因治疗对OAB很有前景，因为可以通过内窥镜检查和其他非常适合基因治疗的微创技术进入所有泌尿生殖器官。
