Pharmacology
A searchable reference to the systemic and topical pharmacotherapy encountered in functional urology, reconstructive urology, and urogynecology — organized by clinical indication rather than chemical class. Type a drug name, agent, or use case in the search box to find the relevant class page.
For intraoperative materials (ICG, hemostatic matrices, fibrin sealants) see the materials-focused Intraoperative Adjuncts section. For implanted devices see Biomaterials.
62 of 62 drug classes
| Drug Class | Category | Key Agents | Clinical Use / Note |
|---|---|---|---|
| Antimuscarinics / Anticholinergics | Storage & OAB | Oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine, trospium | OAB first-line pharmacotherapy; 2022 SUFU white paper flagged dementia risk with chronic use; trospium has minimal CNS penetration |
| β3-Adrenergic Agonists | Storage & OAB | Mirabegron (Myrbetriq), vibegron (Gemtesa) | OAB; vibegron FDA-approved 2024 for men on BPH therapy (COURAGE); no dementia signal |
| Desmopressin | Storage & OAB | DDAVP, NOCDURNA | Nocturnal polyuria; sex-stratified dosing (27.7 mcg women, 55.3 mcg men); hyponatremia monitoring essential |
| Alpha Blockers | Voiding & Outlet | Tamsulosin, silodosin, alfuzosin, doxazosin, terazosin | BPH/LUTS first-line; MET for distal ureteral stones >5 mm; TWOC after AUR; CP/CPPS; IFIS concern |
| 5α-Reductase Inhibitors | Voiding & Outlet | Finasteride (Proscar), dutasteride (Avodart) | BPH with prostate ≥30 mL; MTOPS combination with α-blocker; PSA halving; detection-bias explanation for PCPT/REDUCE high-grade signal |
| Alpha Agonists | Voiding & Outlet | Midodrine, pseudoephedrine, phenylephrine | Mild SUI (off-label, rarely effective); priapism self-detumescence; orthostatic hypotension in autonomic dysfunction |
| Cholinergic Agonists | Voiding & Outlet | Bethanechol | Underactive bladder / detrusor underactivity (limited evidence; largely legacy) |
| Skeletal Muscle Relaxants | Voiding & Outlet | Cyclobenzaprine, baclofen, tizanidine, methocarbamol | Pelvic-floor hypertonicity; detrusor-sphincter dyssynergia (baclofen) |
| Dantrolene | Voiding & Outlet | Dantrium | Direct skeletal muscle relaxation for refractory dyssynergia (historical; hepatotoxicity limits use) |
| Oral IC/BPS Agents | Bladder Pain & IC/BPS | Pentosan polysulfate (Elmiron), amitriptyline, hydroxyzine, cimetidine | IC/BPS systemic therapy; PPS maculopathy requires annual ophthalmologic screening |
| Intravesical Agents | Bladder Pain & IC/BPS | DMSO, heparin, lidocaine, bupivacaine, rescue cocktail (lido + heparin + bicarb) | IC/BPS flare therapy; urothelial GAG replenishment; direct mucosal analgesia |
| Gabapentinoids | Neuropathic & Pelvic Pain | Gabapentin, pregabalin | Neuropathic pelvic pain, pudendal neuralgia, vulvodynia; renally cleared (gabapentin) |
| Tricyclic Antidepressants | Neuropathic & Pelvic Pain | Amitriptyline, nortriptyline, imipramine | IC/BPS, CP/CPPS, neuropathic pelvic pain; amitriptyline is the workhorse; anticholinergic burden |
| SNRIs | Neuropathic & Pelvic Pain | Duloxetine, venlafaxine, milnacipran | Neuropathic pelvic pain; duloxetine FDA-approved for SUI in Europe (not US) |
| NSAIDs & Analgesics | Neuropathic & Pelvic Pain | Ibuprofen, naproxen, celecoxib, acetaminophen, ketorolac | Acute pelvic pain, post-op analgesia, renal colic; part of ERAS narcotic-sparing strategy |
| Topical Compounded Agents | Neuropathic & Pelvic Pain | Compounded amitriptyline, baclofen, gabapentin, ketamine, lidocaine | Refractory vulvodynia, provoked vestibulodynia; topical delivery avoids systemic effects |
| Local Anesthetics | Neuropathic & Pelvic Pain | Lidocaine, bupivacaine, ropivacaine, mepivacaine | Pudendal nerve blocks, intravesical therapy, penile block for IPP and urethroplasty |
| Antispasmodics | Neuropathic & Pelvic Pain | Diazepam (vaginal suppository), cyclobenzaprine, baclofen | Pelvic floor spasticity / levator ani syndrome; diazepam 2-10 mg vaginal suppository is classic |
| Botulinum Toxin | Neuromodulation Adjuncts | OnabotulinumtoxinA (Botox) | Intradetrusor 100 U (idiopathic OAB) or 200 U (NDO); external sphincter for DSD; pelvic floor for spasticity |
| Perioperative Antibiotic Prophylaxis | Infection & Prophylaxis | Cefazolin, vancomycin, gentamicin, ceftriaxone, piperacillin-tazobactam, fluconazole | AUA 2020 BPS framework; device surgery protocols (PUMP/Barham) challenge the AUA recommendations for IPP |
| UTI Treatment Antibiotics | Infection & Prophylaxis | Nitrofurantoin, TMP-SMX, fosfomycin, fluoroquinolones, β-lactams, aminoglycosides | Stratified by uncomplicated vs complicated UTI; local antibiogram + renal function drive selection |
| UTI Suppressive & Prophylactic Therapy | Infection & Prophylaxis | Nitrofurantoin 50-100 mg qhs, low-dose TMP/SMX, cephalexin, post-coital regimens | Recurrent UTI prevention; AUA guideline favors 3-6 month courses with periodic re-evaluation |
| Non-Antibiotic UTI Prevention | Infection & Prophylaxis | Methenamine, D-mannose, vaginal estrogen, cranberry, probiotics | Stewardship-focused alternatives; methenamine + vaginal estrogen strongest evidence; ALTAR trial |
| Antifungals | Infection & Prophylaxis | Fluconazole, amphotericin B, echinocandins | Prosthetic infection prevention (PUMP 92% reduction); candiduria; ascending fungal UTI |
| Prosthetic Infection & Biofilm Protocols | Infection & Prophylaxis | IPP dipping solutions (vanc-gent, Irrisept by device), salvage washout regimens | Device-specific protocols: do-not-dip InhibiZone vs vanc-gent dip for hydrophilic Titan; 2026 CHG pivot for Titan |
| PDE-5 Inhibitors | Sexual Medicine & Andrology | Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), avanafil (Stendra) | ED first-line; tadalafil 5 mg daily also FDA-approved for BPH/LUTS; nitrate contraindication absolute |
| Intracavernosal Injection Agents | Sexual Medicine & Andrology | Alprostadil (Caverject/Edex), bimix, trimix, quadmix | ED refractory to oral therapy; ~80% success; priapism risk 1%; trimix is specialty workhorse |
| Intraurethral Alprostadil | Sexual Medicine & Andrology | MUSE (Medicated Urethral System for Erection) | Needle-free ED option; PGE1 urethral suppository; less effective than ICI |
| Testosterone Replacement | Sexual Medicine & Andrology | Cypionate/enanthate IM, transdermal (AndroGel/Testim), pellets (Testopel), SC auto-injector (Xyosted), nasal (Natesto), oral (Jatenzo) | Hypogonadism; monitor T, CBC, PSA; not a first-line ED treatment alone |
| Androgen Adjuncts | Sexual Medicine & Andrology | hCG, clomiphene, enclomiphene (Enclomid), anastrozole | Fertility-preserving alternatives to TRT; maintain spermatogenesis while raising endogenous T |
| Peyronie's Disease Agents | Sexual Medicine & Andrology | Collagenase clostridium histolyticum (Xiaflex), interferon α-2b, verapamil | CCH only FDA-approved; IMPRESS I/II ~8° net curvature reduction; corporal rupture ~0.5% |
| Priapism Management | Sexual Medicine & Andrology | Intracavernosal phenylephrine, etilefrine, pseudoephedrine, daily low-dose PDE5i (SCD prevention) | Acute detumescence (phenylephrine 100-500 mcg q3-5 min); stuttering prevention in SCD |
| Vaginal & Topical Estrogen | Hormonal Therapies | Estradiol cream/ring (Estring)/tablet (Vagifem), conjugated equine estrogen cream (Premarin) | Genitourinary syndrome of menopause (GSM); rUTI prevention (AUA-endorsed); minimal systemic absorption at low dose |
| Vaginal DHEA | Hormonal Therapies | Prasterone (Intrarosa) 6.5 mg | GSM alternative for patients with hormone-sensitive cancer history; converts locally to estrogens/androgens |
| Ospemifene | Hormonal Therapies | Osphena 60 mg daily | SERM for dyspareunia from GSM; oral systemic alternative to vaginal therapy |
| Preoperative Hormonal Priming | Hormonal Therapies | Topical estrogen 4-6 weeks before vaginal surgery | Tissue quality optimization before prolapse / sling / UVF repair in postmenopausal patients |
| Gender-Affirming Hormone Therapy | Hormonal Therapies | Estradiol, testosterone, progesterone, spironolactone, GnRH agonists | Perioperative context for gender-affirming surgery; WPATH SOC8 guidance; hold estrogen peri-vaginoplasty |
| High-Potency Topical Corticosteroids | Dermatologic & Topical Urethral | Clobetasol 0.05%, betamethasone, mometasone | Lichen sclerosus (BXO) — first-line; vulvar dermatoses; preserves function, reduces urethral stricture recurrence |
| Topical Calcineurin Inhibitors | Dermatologic & Topical Urethral | Tacrolimus 0.1% (Protopic), pimecrolimus (Elidel) | Steroid-sparing maintenance for LS / vulvar dermatoses; avoid prolonged corticosteroid exposure |
| Intralesional Corticosteroids | Dermatologic & Topical Urethral | Triamcinolone acetonide | Hunner lesions, refractory LS flares, keloid / hypertrophic scar, urethral stricture resistant to dilation |
| Antimitotics & Antifibrotics | Dermatologic & Topical Urethral | Mitomycin C, triamcinolone | Urethral stricture prevention adjunct; applied at endoscopic incision or urethroplasty site |
| Drug-Coated Balloon Therapy | Dermatologic & Topical Urethral | Optilume (paclitaxel-coated balloon) | Anterior urethral stricture treatment; antifibrotic delivered during dilation; ROBUST III FDA approval |
| Platelet-Rich Plasma | Dermatologic & Topical Urethral | Autologous PRP injection | Regenerative urology (emerging); vulvovaginal, Peyronie's, ED; evidence base developing |
| Visualization Agents | Intraoperative Adjuncts | ICG, methylene blue, indigo carmine, sodium fluorescein, pudexacianinium (ASP-5354) | Perfusion mapping, ureter ID, lymphatic mapping, fistula localization; NIR hardware needed for ICG/pudexacianinium |
| Hemostatic Agents | Intraoperative Adjuncts | Surgicel, Arista AH, Gelfoam/Surgiflo, FloSeal, topical thrombin (Evithrom/Recothrom) | Diffuse oozing; passive matrices vs active (thrombin); FloSeal for PN renal bed |
| Tissue Sealants | Intraoperative Adjuncts | Fibrin sealants (Tisseel/Evicel/Artiss), TachoSil, cyanoacrylates (Dermabond), PEG (CoSeal) | Anastomotic reinforcement, tunical sealing (PICS technique for Peyronie's), skin closure |
| Vasoconstrictors | Intraoperative Adjuncts | Epinephrine 1:100,000 to 1:1,000,000 in saline, phenylephrine | Local infiltration hemostasis; avoid in penis and digit tips; not in IPP field |
| Hydrodissection Agents | Intraoperative Adjuncts | Saline, saline + epinephrine, saline + lidocaine | Tissue plane development; vaginal flap elevation; urethroplasty dissection |
| Tranexamic Acid | Intraoperative Adjuncts | TXA — IV, oral, topical, irrigation | Antifibrinolytic; reduces surgical bleeding in prostatectomy, cystectomy, urogynecologic surgery |
| Liposomal Bupivacaine | Intraoperative Adjuncts | Exparel (bupivacaine liposome injectable suspension) | Extended 72+ hour local analgesia; infiltration at closure; IPP, urethroplasty, urogynecologic surgery ERAS pathways |
| VTE Prophylaxis | Perioperative & ERAS | Enoxaparin, unfractionated heparin, rivaroxaban, apixaban, SCDs | Postoperative thromboprophylaxis; AUA guideline stratified by procedure and patient risk |
| Anticoagulation Reversal | Perioperative & ERAS | Andexanet alfa, idarucizumab, 4-factor PCC, vitamin K, protamine | Emergent reversal for bleeding or urgent surgery; agent-specific by anticoagulant |
| Bowel Preparation | Perioperative & ERAS | PEG (MoviPrep, GoLYTELY), sodium phosphate, oral antibiotics (neomycin + erythromycin/metronidazole) | Before urinary diversion, ileal conduit, augmentation; mechanical + antibiotic bowel prep debate |
| Post-op Bowel & Ileus Management | Perioperative & ERAS | Alvimopan (Entereg), simethicone, bisacodyl, docusate, metoclopramide, prokinetics | ERAS ileus prevention; alvimopan reduces time to GI recovery in urinary diversion |
| Corticosteroids | Perioperative & ERAS | Dexamethasone (PONV, airway, allergic), methylprednisolone (inflammation), prednisone (flares) | PONV prophylaxis, airway edema, immunologic flares; single-dose intraop dex is standard |
| Urinary Acidifiers | Urinary Diversion-Specific | Sodium bicarbonate (for acidosis), ammonium chloride, ascorbic acid | Acid-base management in ileal conduit / orthotopic neobladder; monitor chloride, bicarb |
| Vitamin B12 Supplementation | Urinary Diversion-Specific | Cyanocobalamin IM or oral, methylcobalamin | Post-ileal-resection B12 deficiency; annual B12 monitoring after ileal diversion |
| Mucus Management | Urinary Diversion-Specific | N-acetylcysteine, saline irrigation, bicarbonate irrigation | Conduit / pouch mucus reduction; prevents catheter obstruction in continent reservoirs |
| Parasympathomimetics | Legacy & Low-Evidence | Bethanechol, neostigmine, pyridostigmine | Underactive bladder; evidence weak; largely legacy; bethanechol still used in refractory DUA |
| Imipramine | Legacy & Low-Evidence | Tofranil | Historical stress incontinence and childhood nocturnal enuresis; largely superseded |
| Phenazopyridine | Legacy & Low-Evidence | Pyridium, AZO | Symptomatic urinary analgesic; 2-day max; orange urine; screening artifact; hemolysis in G6PD |
| Phytotherapy | Legacy & Low-Evidence | Saw palmetto (Serenoa repens), beta-sitosterol, pumpkin seed, Pygeum africanum | BPH symptom relief; Cochrane 2012 found no benefit over placebo for saw palmetto; patient interest persists |
Organizing Framework
Pharmacology in functional and reconstructive urology is organized by clinical indication rather than chemical class — a patient presents with a functional problem (storage, voiding, pain, infection, sexual dysfunction, hormonal need), and the surgeon selects the drug class that addresses it. The 13 categories above correspond to the reconstructive urologist's prescribing pathway.
Structure at a glance
Lower-urinary-tract function
- Storage & OAB — antimuscarinics, β3-agonists, desmopressin
- Voiding & Outlet — α-blockers, 5-ARIs, α-agonists, cholinergic agonists, skeletal muscle relaxants, dantrolene
Pain syndromes
- Bladder Pain & IC/BPS — oral and intravesical
- Neuropathic & Pelvic Pain — gabapentinoids, TCAs, SNRIs, NSAIDs, topical compounded, local anesthetics, antispasmodics
Advanced / procedural
- Neuromodulation Adjuncts — botulinum toxin
- Infection & Prophylaxis — antibiotics, antifungals, prosthetic-device protocols
- Sexual Medicine & Andrology — ED, Peyronie's, priapism, TRT
- Hormonal Therapies — GSM, preop priming, GAHT
Topical / regenerative
- Dermatologic & Topical Urethral — BXO/LS, stricture adjuncts, PRP, DCB therapy
Surgical window
- Intraoperative Adjuncts — visualization, hemostasis, sealants, vasoconstrictors, hydrodissection, TXA, Exparel
- Perioperative & ERAS — VTE prophylaxis, AC reversal, bowel, ileus, corticosteroids
- Urinary Diversion-Specific — acidifiers, B12, mucus
Historical
- Legacy & Low-Evidence — agents whose use has been superseded or whose evidence did not hold up
Out of Scope
This pharmacology section does not cover:
- Chemotherapy and immunotherapy for urologic malignancy
- Androgen deprivation therapy for prostate cancer (TRT for hypogonadism is covered)
- Medical expulsive therapy (MET) for stones is included as an α-blocker use case; stone-specific workup is otherwise outside WARWIKI's functional scope
For intraoperative materials (ICG, methylene blue, Surgicel, fibrin sealants, TachoSil) in a materials-focused reference, see Intraoperative Adjuncts under Tools. For implanted devices see Biomaterials.
Development Status
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Fully-built class pages (4): Anticholinergics · β3-agonists · Desmopressin · Alpha Blockers · 5α-Reductase Inhibitors
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Structure with stubs (~60 pages): all other classes — each has a placeholder page following the standard WARWIKI drug-class template, filled out progressively as content is reviewed and ratified.
Every fully-built class page covers: overview, mechanism, agents in class, indications in reconstructive urology, dosing, contraindications, perioperative considerations, evidence summary, practical pearls, related articles, references.