Pharmacotherapy of bladder dysfunction — past, present and future

Overactive bladder (OAB) encompasses a variety of conditions that may necessitate different therapeutic strategies. This diversity is evident in the wide range of medications used over the past five decades. Unfortunately, we have too few tools to identify individual conditions and even less information about which condition is best served by which treatment. Many of the drugs have been discontinued primarily due to an unfavorable balance between efficacy and adverse effects. As a result, current treatment guidelines primarily recommend antimuscarinics and β 3-adrenoceptor agonists, with intravesical botulinum toxin injections as a second-line option. While these treatments have documented efficacy, their use is often limited by side effects, adherence challenges, and persistence issues. Personalized treatment approaches may help optimize the use of these medications. However, there is a need for improved therapies, and many promising future therapeutic alternatives can be discussed. However, there seem to be no drugs ready for immediate clinical introduction.