Pathophysiology of Overactive Bladder and Pharmacologic Treatments Including β3-Adrenoceptor Agonists -Basic Research Perspectives

Overactive bladder (OAB) is a symptom-based syndrome defined by urinary urgency, frequency, and nocturia with or without urge incontinence. The causative pathology is diverse; including bladder outlet obstruction (BOO), bladder ischemia, aging, metabolic syndrome, psychological stress, affective dis...

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Vydané v:International neurourology journal Ročník 28; číslo Suppl 1; s. 12 - 33
Hlavní autori: Kwon, Joonbeom, Kim, Duk Yoon, Cho, Kang Jun, Hashimoto, Mamoru, Matsuoka, Kanako, Kamijo, Tadanobu, Wang, Zhou, Karnup, Sergei, Robertson, Anne M., Tyagi, Pradeep, Yoshimura, Naoki
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Korea (South) Korean Continence Society 01.02.2024
대한배뇨장애요실금학회
Predmet:
overactive bladder
pathophysiology
Review
β3-adrenergic receptors
β3-agonists
비뇨기과학
Overactive bladder
Pathophysiology
β3-Adrenergic receptors
β3-Agonists
ISSN:2093-6931, 2093-4777, 2093-6931
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Popis
Shrnutí:Overactive bladder (OAB) is a symptom-based syndrome defined by urinary urgency, frequency, and nocturia with or without urge incontinence. The causative pathology is diverse; including bladder outlet obstruction (BOO), bladder ischemia, aging, metabolic syndrome, psychological stress, affective disorder, urinary microbiome, localized and systemic inflammatory responses, etc. Several hypotheses have been suggested as mechanisms of OAB generation; among them, neurogenic, myogenic, and urothelial mechanisms are well-known hypotheses. Also, a series of local signals called autonomous myogenic contraction, micromotion, or afferent noises, which can occur during bladder filling, may be induced by the leak of acetylcholine (ACh) or urothelial release of adenosine triphosphate (ATP). They can be transmitted to the central nervous system through afferent fibers to trigger coordinated urgency-related detrusor contractions. Antimuscarinics, commonly known to induce smooth muscle relaxation by competitive blockage of muscarinic receptors in the parasympathetic postganglionic nerve, have a minimal effect on detrusor contraction within therapeutic doses. In fact, they have a predominant role in preventing signals in the afferent nerve transmission process. β3-adrenergic receptor (AR) agonists inhibit afferent signals by predominant inhibition of mechanosensitive Aδ-fibers in the normal bladder. However, in pathologic conditions such as spinal cord injury, it seems to inhibit capsaicin-sensitive C-fibers. Particularly, mirabegron, a β3-agonist, prevents ACh release in the BOO-induced detrusor overactivity model by parasympathetic prejunctional mechanisms. A recent study also revealed that vibegron may have 2 mechanisms of action: inhibition of ACh from cholinergic efferent nerves in the detrusor and afferent inhibition via urothelial β3-AR.
Bibliografia:ObjectType-Article-1
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https://doi.org/10.5213/inj.2448002.001
ISSN:2093-6931
2093-4777
2093-6931
DOI:10.5213/inj.2448002.001