Andersson Karl-Erik
Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina 27157, United States.
Discov Med. 2009 Oct;8(42):118-24.
Lower urinary tract symptoms (LUTS), the overactive bladder syndrome (OAB), and detrusor overactivity (DO) are all conditions that can have major effects on quality of life and social functioning. Antimuscarinic drugs are first-line treatment--they often have good initial response rates, but adverse effects and decreasing efficacy cause long-term compliance problems, and alternatives are needed. The recognition of the functional contribution of the urothelium, the spontaneous myocyte activity during bladder filling, and the diversity of nerve transmitters involved has sparked interest in both peripheral and central modulation of LUTS/OAB/DO pathophysiology. There may be several new possibilities to treat LUTS/OAB/DO. For example, beta3-adrenoceptor (AR) agonists (mirabegron), phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil), combinations (alpha1-AR antagonist+antimuscarinic), and drugs with a central mode of action (tramadol, gabapentin) all have positive proof of concept documented in randomized, controlled trials. Which of these therapeutic principles will be developed to become clinically useful treatments remain to be established.
下尿路症状（LUTS）、膀胱过度活动症（OAB）和逼尿肌过度活动（DO）都是会对生活质量和社交功能产生重大影响的病症。抗毒蕈碱药物是一线治疗药物——它们通常有较好的初始有效率，但不良反应和疗效降低会导致长期依从性问题，因此需要其他替代药物。对尿路上皮的功能作用、膀胱充盈期间自发的肌细胞活动以及所涉及神经递质多样性的认识，引发了人们对LUTS/OAB/DO病理生理学外周和中枢调节的兴趣。治疗LUTS/OAB/DO可能有几种新方法。例如，β3肾上腺素能受体（AR）激动剂（米拉贝隆）、5型磷酸二酯酶抑制剂（西地那非、他达拉非、伐地那非）、联合用药（α1-AR拮抗剂+抗毒蕈碱药物）以及具有中枢作用模式的药物（曲马多、加巴喷丁）在随机对照试验中均有积极的概念验证记录。这些治疗原则中哪些会发展成为临床上有用的治疗方法仍有待确定。
