Controversy over the pharmacological treatments of storage symptoms in spinal cord injury patients: a literature overview

Study design: Our aim was to locate research and communicate the evidence found from scientific studies pertaining to the treatment of neurogenic detrusor overactivity (NDO) in the chronic stage of spinal cord injury (SCI). Objective: To address the controversy over the traditional (antimuscarinics) and the 'new' treatments for NDO and try to offer an insight on the rationale underlying the development of new drugs such as botulinum toxin (BTX), vanilloids, nociceptin/orphanin FQ. As a final point, to provide information on a new class of cation channels, the Degenerin/Epithelial Na(+)Channel (Deg/ENaC) Family that could be future targets for the management of NDO. Setting: International. Methods: Overview of English literature on drug management of NDO. Results: Agents that block the 'efferent' function of micturition reflex, such as antimuscarinics, are currently first-line therapy for NDO. They reach the highest level of evidence (1a) and grade of recommendation (A). However, many patients and physicians believe that the 'efferent' pharmacological management of NDO is not completely satisfactory. Consequently, research is trying to address issues of efficacy, tolerability and convenience of new therapeutic strategies targeting the 'afferent' function. Conclusion: Antimuscarinic therapy increases the bladder capacity and delays the initial urge to void. However, in some patients they fail to achieve the patient's therapeutic goals. New interesting approaches have been investigated in the last few years. BTX seems to be very promising in treating neurogenic overactive bladder (OAB), but other compounds are now on the horizon. Spinal Cord (2012) 50, 8-13; doi:10.1038/sc.2011.110; published online 1 November 2011