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Overactive Bladder
Fesoterodine – A New Treatment Option for Overactive Bladder
a report by
Klaus-Peter Jünemann and Christoph Seif
Department of Urology and Paediatric Urology, University Hospital Schleswig Holstein, Kiel
Overactive bladder (OAB) syndrome is a widespread problem that has darifenacin and tolterodine, constitute the primary pharmacological
a significant negative impact on the quality of life (QoL) of sufferers. treatments for the relief of OAB symptoms.
OAB is a collection of symptoms that the International Continence
Society (ICS) defines as urgency, with or without urgency urinary Muscarinic receptors have a vital impact on the action of acetylcholine, a
incontinence (UUI), usually accompanied by increased micturition common neurotransmitter in the parasympathetic nerve endings that
frequency and nocturia.
1
The chronic condition affects both men and induces smooth-muscle contractions. The cholinergic signalling is mediated
women and its incidence increases with advancing age.
2
EPIC, a recent by the muscarinic acetylcholine receptor expressed on the surface of the
international population-based study performed in over 19,000 smooth-muscle cells. To date, five subtypes (M1–M5) of muscarinic
individuals,
3
used the current ICS definitions to determine the receptors have been identified, and are variable in terms of both tissue
prevalence of OAB. The study reported an overall OAB prevalence of distribution and signal transduction mechanisms.
5
Delineating the role of
11.8%; OAB prevalence ranged from 7 to 10% in individuals <39 these receptors has been a matter of considerable interest since they are
years of age, and nearly 20% of individuals ≥60 years of age were promising therapeutic targets for various diseases. For instance, M1, M3
affected by OAB. and M5 receptor antagonists exhibit antipsychotic behaviour in animal
models. Antagonism of M5 receptors could present a novel approach to
The underlying cause of OAB is multifactorial and often undetermined. the treatment of disorders such as schizophrenia and compound
Generally, the physiological basis of OAB is attributed to dysfunctional addiction.
6
M2 and M3 are the main muscarinic receptors expressed in
activity of the detrusor muscle. Treatment modalities focus on gastrointestinal smooth muscle, and their activation by acetylcholine results
symptomatic relief. Current treatment regimens include both non- in abrogating muscle relaxation.
6
Despite this, antagonists used in OAB
pharmacological (behavioural therapy, coping strategies, protective management often have diverse selectivity. They are efficient at alleviating
garments, barrier devices, pelvic floor stimulation or sacral nerve the symptoms of OAB, but are associated with serious dose-dependent
stimulation) and pharmacological components.
4
Antimuscarinic increases in adverse effects.
agents, including oxybutynin, propiverine hydrochloride, solifenacin,
Pharmacological management of OAB continues to evolve as further
evaluations of current and developmental agents continue. Two phase
Klaus-Peter Jünemann is Head of the Department of Urology
III clinical trials have demonstrated that a novel antimuscarinic agent,
and Paediatric Urology at the Keil Campus of University
Hospital Schleswig-Holstein. Prior to this, he was Assistant fesoterodine (Toviaz
®
), is an effective and well-tolerated therapy for
Medical Director of the Deptartment of Urology at Heidelberg
OAB. Fesoterodine has recently been approved in Europe for the
University. Professor Jünemann’s many areas of scientific
expertise range from incontinence treatment to nerve-sparing
treatment of symptoms of OAB syndrome including increased urinary
prostate surgery and erectile rehabilitation to andrology to frequency and/or urgency, and/or urge incontinence.
7
The efficacy and
child urology. In the course of his career he has been
safety profiles of fesoterodine are the focus of this short review.
awarded countless prizes and is a member of numerous
international and national associations, such as the American and the European Urological
Associations (AUA and EAU), as well as the Society for Urodynamics and Female Urology
Overactive Bladder Symptoms –
(SUFU) and the International Continence Society (ICS). He is also Head of the German
Continence Society. During his training period he was awarded two research fellowships at the
Compromised Quality of Life
University of California under Professor EA Tanagho. He has been a certified urologist since OAB negatively affects several aspects of QoL. The condition restricts the
1991. Professor Jünemann received his Approbation at the Philipps-University Marburg/Lahn.
amount of physical activity the patient will or can perform. Occupationally,
E: juenemann@uksh-kiel.de OAB can lead to absence from work and, therefore, decreased productivity.
Christoph Seif is Senior Assistant Medical Director at the
Social interaction and travel are also limited. Psychologically, OAB can
University Hospital in Kiel. He is an active and successful negatively affect the patient by causing guilt or depression, loss of self-
researcher, specialising in neurourology, with numerous
esteem, fear of being a burden, lack of bladder control or odour of urine.
publications in this field. Moreover, he has obtained
additional qualifications in special urological surgery,
For hygienic reasons, specialised underwear (pads) and bedding may be
medicinal tumour therapy and andrology, and is a member
required for OAB patients. Finally, OAB is associated with increased risk of
of numerous national and international urological societies.
Dr Seif received his degree in human medicine at Heidelberg
urinary tract infections, fractures related to falls and skin infections.
8
University in 1999 and his MD in 2001, and became a
certified urologist in 2004.
As OAB requires long-term treatment it is desirable to minimise any
unwanted effects of medication to improve tolerability and thus
Supported by an educational grant from Pfizer. The views expressed are those of the authors, and not necessarily those of Pfizer.
62 © TOUCH BRIEFINGS 2008