Potential targets in the treatment of urinary incontinence.

Urgency and involuntary urine loss are distressing problems for both men and women. Attempts to block the primary cholinergic excitatory input to the bladder have led to a number of anticholinergic agents, but treatment with anticholinergics, the current first-line therapy, is not always effective. Metabolic and growth factor receptor targets are being investigated as a way to control the signal transduction process that leads to bladder contraction as well as the release of calcium that triggers this process. Because of the redundancy in mechanisms that promote bladder contraction, it is necessary to investigate multiple targets. Medical research is also focusing on purinergic receptors, the targeting of normally silent C-fibers that become activated due to neuroplasticity in the bladder, nerve-growth-factor blockade, and the blockade of neurotransmitters that control the bladder. Moreover, a strong correlation appears to exist between depression and the occurrence of incontinence, and there is evidence that points to a genetic link. However, the problem, with attacking this multiplicity of sites lies in establishing therapeutic efficacy and a high degree of specificity.