Urinary incontinence: focus on overactive bladder. Topical aspects of clinical features, diagnosis, and treatment at the outpatient stage

The issue of urinary incontinence is multidisciplinary. Such patients present to general practitioners, pediatricians, urologists, gynecologists, neurologists. Often, it is a first-contact physician (primary care provider, general practitioner) that patients come to with this delicate problem, if there is a trusting relationship between the physician and the patient. The review reports topical aspects of the clinical features, diagnosis, and treatment of urge urinary incontinence (overactive bladder) at the outpatient stage. M-anticholinergics currently represent the “gold standard” of drug therapy of incontinence associated with the detrusor overactivity. However, concerns have emerged in recent years that M-anticholinergics also can block M1and M2 receptors in the brain. These receptors are responsible for high cognitive functioning, and abnormalities of those can result in side effects associated with learning, memory, and confusion. Trospium chloride, the quaternary amine, is almost unable to cross the blood-brain barrier, in contrast to tertiary amines; it is considered as a drug of choice for treatment of overactive bladder, especially in patients with comorbidities and elderly patients at risk of dementia. The analysis of the trospium chloride pharmacokinetics and pharmacodynamics has made it possible to determine a number of other trospium chloride advantages over tertiary amines.