Pharmacology of the lower urinary tract and management of overactive bladder

CHAPPLE, Christopher R.; Canda, Abdullah Erdem; CROSS, Rebecca L.

Pharmacology of the lower urinary tract and management of overactive bladder

Abdullah Erdem CANDA, (Royal Hallamshire Hosp. Department, of Urology, Section of Reconstruction Sheffield, UK)

Rebecca L. CROSS, (Royal Hallamshire Hosp. Department, of Bomedical Science, Sheffield, UK)

Christopher R. CHAPPLE (Royal Hallamshire Hosp. Department, of Bomedical Science, Sheffield, UK)

Journal of the Turkish-German Gynecological Association

13 0

Yıl: 2006 Cilt: 7 Sayı: 2 Sayfa Aralığı: 146 - 157 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Pharmacology of the lower urinary tract and management of overactive bladder

Öz:

Alt üriner sistemin temel fonksiyonları idrarın depolanması ve boşaltılmasıdır. Bunun için spesifik reseptörler ve transmiterler rol oynamaktadır. Mesanenin kontraksiyonu kolinerjik, adrenerjik ve non-adrenerjik, non-kolinerjik (NANC) mekanizmalar ile olur. Parasempatik sistem temel olarak mesanenin boşalmasından sorumludur. Muskarinik reseptörler detrusor kasında, ürotelyumda ve parasempatik/sempatik sinir uçlarında yer alırlar. Mesanede her ne kadar M2-muskarinik reseptörler sayıca baskın olsalar da, detrusor kontraksiyonu ve işeme fonksiyonunda asıl önemli olanlar M3-muskarinik reseptörlerdir. β-adrenoreseptörler postsinaptik olarak α-reseptörlere göre sayıca baskındırlar ve relaksasyona neden olurlar. Pürinerjik sistem/ ATP, nitrik oksit, prostanoidler, lökotrienler, nöropeptidler ve reseptörlerinden oluşan küçük bir NANC komponenti de mesane kontraksiyonuna katkıda bulunur. Ayrıca histamin, serotonin ve vaniloid reseptörleri de mesane fonksiyonunda rol oynarlar. Mesanede, daha çok subüretelyumda pleksus oluşturan ve detrusor kasında da yerleşen duyusal sinirler gösterilmiştir. Sık rastlanan bir bozukluk olan aşırı aktif mesanenin, inhibisyonun kaybı ya da çeşitli seviyelerdeki anormal eksitabiliteye bağlı geliştiği öne sürülmektedir. Aşırı aktif mesane günümüzde davranış ve ilaç tedavisinin kombinasyonu ile tedavi edilmektedir. Her ne kadar daha önce aşırı aktif mesane tedavisinde non-selektif ilaçlar kullanılmış olsa da, günümüzde oksibutinin, tolterodrin, solifenasin ve darifenasin gibi daha selektif ajanlar giderek artan sıklıkta kullanılmaktadır. Aşırı aktif mesane tedavisinde gelecekte özellikle afferent sinirleri etkileyerek fonksiyon gösteren ajanların geliştirilmesi umut verici bir hedeftir

Anahtar Kelime: Mesane, aşırı aktif Tedavi Ürolojik hastalıklar

Konular: Kadın Hastalıkları ve Doğum

Alt üriner sistemin farmakolojisi ve aşırı aktif mesanenin tedavisi

Öz:

The main functions of the lower urinary tract (LUT) are urine storage and emptying. The specific receptors and transmitters take part in this process. Bladder contraction is mediated by cholinergic, adrenergic and nonadrenergic and noncholinergic (NANC) mechanisms. Parasympathetic nervous system is mainly responsible for bladder emptying and muscarinic receptors are detected on detrusor smooth muscle, urothelium and on the parasympathetic/sympathetic nerve endings. Although M2- muscarinic receptor subtype is predominating in number, M3-receptor subtype was identified as the predominant mediator of detrusor contration for normal micturition. β-adrenoreceptors are predominant over α-receptors postjunctionally which cause relaxation. A small NANC component seems to be contributing to the contraction of the detrusor which includes purinergic system/ATP, nitric oxide, prostanoids, leukotrienes, neuropeptides and their receptors. Additionally, histamine, serotonin and vanilloid receptors also take part in bladder function. Sensory nerves have been demostrated suburothelially where they form a plexus as well as in the detrusor muscle. Overactive bladder (OAB) is a common disorder which has been suggested to occur due to a loss of inhibition or abnormal excitability at various levels. Currently, OAB is treated primarily by a combination of behavioral modification and drug therapy. Although the nonselective antimuscarinic agents have been used in the treatment of patients with OAB in the past, currently more selective antimuscarinic drugs such as oxybutynin, tolterodine, solifenacin and darifenacin are being used more frequently. Development of agents acting particularly on the afferent nerves in the bladder seems to be a promising target for the management of OAB in the future.

Anahtar Kelime: Urinary Bladder, Overactive Therapy Urologic Diseases

Konular: Kadın Hastalıkları ve Doğum

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	Canda A, CROSS R, CHAPPLE C (2006). Pharmacology of the lower urinary tract and management of overactive bladder. , 146 - 157.
Chicago	Canda Abdullah Erdem,CROSS Rebecca L.,CHAPPLE Christopher R. Pharmacology of the lower urinary tract and management of overactive bladder. (2006): 146 - 157.
MLA	Canda Abdullah Erdem,CROSS Rebecca L.,CHAPPLE Christopher R. Pharmacology of the lower urinary tract and management of overactive bladder. , 2006, ss.146 - 157.
AMA	Canda A,CROSS R,CHAPPLE C Pharmacology of the lower urinary tract and management of overactive bladder. . 2006; 146 - 157.
Vancouver	Canda A,CROSS R,CHAPPLE C Pharmacology of the lower urinary tract and management of overactive bladder. . 2006; 146 - 157.
IEEE	Canda A,CROSS R,CHAPPLE C "Pharmacology of the lower urinary tract and management of overactive bladder." , ss.146 - 157, 2006.
ISNAD	Canda, Abdullah Erdem vd. "Pharmacology of the lower urinary tract and management of overactive bladder". (2006), 146-157.

APA	Canda A, CROSS R, CHAPPLE C (2006). Pharmacology of the lower urinary tract and management of overactive bladder. Journal of the Turkish-German Gynecological Association, 7(2), 146 - 157.
Chicago	Canda Abdullah Erdem,CROSS Rebecca L.,CHAPPLE Christopher R. Pharmacology of the lower urinary tract and management of overactive bladder. Journal of the Turkish-German Gynecological Association 7, no.2 (2006): 146 - 157.
MLA	Canda Abdullah Erdem,CROSS Rebecca L.,CHAPPLE Christopher R. Pharmacology of the lower urinary tract and management of overactive bladder. Journal of the Turkish-German Gynecological Association, vol.7, no.2, 2006, ss.146 - 157.
AMA	Canda A,CROSS R,CHAPPLE C Pharmacology of the lower urinary tract and management of overactive bladder. Journal of the Turkish-German Gynecological Association. 2006; 7(2): 146 - 157.
Vancouver	Canda A,CROSS R,CHAPPLE C Pharmacology of the lower urinary tract and management of overactive bladder. Journal of the Turkish-German Gynecological Association. 2006; 7(2): 146 - 157.
IEEE	Canda A,CROSS R,CHAPPLE C "Pharmacology of the lower urinary tract and management of overactive bladder." Journal of the Turkish-German Gynecological Association, 7, ss.146 - 157, 2006.
ISNAD	Canda, Abdullah Erdem vd. "Pharmacology of the lower urinary tract and management of overactive bladder". Journal of the Turkish-German Gynecological Association 7/2 (2006), 146-157.