Antimuscarinic drugs are still first-line treatment for the symptoms of overactive bladder (OAB) and are associated with good initial response rates. Adverse effects and decreasing efficacy over the longer term do, however, limit their overall effectiveness. As such, alternatives to antimuscarinics 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 in the symptoms of the OAB has sparked interest in pharmacologic manipulation of both peripheral and central pathophysiology. Some of the treatments currently under investigation are discussed in this review. Antimuscarinic drugs are first-line treatment for the overactive bladder syndrome (OAB). Despite having good initial response rates, however, adverse effects and decreasing efficacy cause long-term compliance problems. It is therefore desirable that alternative treatment methods be developed and made available. This is currently a rich field of research, as many compounds with potential efficacy for the treatment of OAB are undergoing preclinical and clinical testing. In OAB, there are many potential pathophysiologic targets for intervention, and this is reflected by the broad variety of mechanisms amongst the agents in development. Broadly speaking, drugs for OAB are designed to target mucosal (urothelial) signaling, myocyte signaling or the central nervous system. This brief review presents the potential treatment pathways, discusses whether or not they hold promise and briefly summarizes the key evidence gathered to date.
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