Drugs and future candidates.

Antimuscarinic drugs are still first-line treatment for the symptoms of overactive bladder (OAB) and are associated with good initial response rates. Adverse effects and decreasing efficacy over the longer term do, however, limit their overall effectiveness. As such, alternatives to antimuscarinics are needed. The recognition of the functional contribution of the urothelium, the spontaneous myocyte activity during bladder filling, and the diversity of nerve transmitters involved in the symptoms of the OAB has sparked interest in pharmacologic manipulation of both peripheral and central pathophysiology. Some of the treatments currently under investigation are discussed in this review.