Pharmacology of the lower urinary tract provides the basis for medical treatment of
lower urinary tract symptoms (LUTS).
Therapy of LUTS addresses obstructive symptoms (frequently explained by increased prostate smooth muscle tone and prostate enlargement) in patients with benign prostate
hyperplasia (BPH) and storage symptoms in patients with
overactive bladder (OAB). Targets for medical treatment include
G protein-coupled receptors (α1-
adrenoceptors,
muscarinic acetylcholine receptors, β3-
adrenoceptors) or intracellular
enzymes (5α-
reductase;
phosphodiesterase-5, PDE5). Established
therapies of obstructive symptoms aim to induce prostate smooth muscle relaxation by α1-blockers or
PDE5 inhibitors, or to reduce prostate growth and volume with 5α-reductase inhibitors. Available options for treatment of OAB comprise anitmuscarinics, β3-adrenoceptor agonists, and
botulinum toxin A, which improve storage symptoms by inhibition of bladder smooth muscle contraction. With the recent approval of β3-antagonists, PDE inhibitors, and
silodosin for
therapy of LUTS, progress from basic research of lower urinary tract pharmacology was translated into new clinical applications. Further targets are in preclinical stages of examination, including modulators of the
endocannabinoid system and transient receptor potential (TRP) channels.