Management of overactive bladder--looking to the future.

OBJECTIVES

To offer a perspective on potential future advances in the understanding and management of the overactive bladder.

METHODS

Consideration is given to potential developments in the areas of pathophysiology, prevention, early intervention, and new pharmacologic targets for the treatment of overactive bladder.

RESULTS

The future will likely reveal that motor urgency is usually a premature micturition reflex with a limited and variable degree of penetrance. Overactivity of all types in the lower urinary tract (LUT) will be regarded as the result of a partially uncontrolled on-off mechanism in the nervous system. Neurogenic factors will be found to initiate a premature activation of urethral and bladder activity, whereas myogenic factors will be recognized as serving as facilitators. As is the case today, we will probably be unable to cure or normalize the overactive bladder in the future. However, our growing understanding of the pathophysiology of the LUT will open up new possibilities for prophylactic, diagnostic, and therapeutic measures. Advances in cellular and molecular biology may allow early intervention or even prevention of the overactive bladder. Pharmacologic treatment will not only aim at functional intervention, but will attempt to influence the structure of the organs by means of trophically active drugs. Prevention of muscle cell hypertrophy and induction of nerve growth might become therapeutic realities.

CONCLUSIONS

The future holds the promise of important advances that will improve our understanding of the overactive bladder and will hopefully lead to more effective treatments.