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; chronic-use dementia signal; trospium minimal CNS |
| β3-Adrenergic Agonists | Storage & OAB | Mirabegron (Myrbetriq), vibegron (Gemtesa) | OAB; vibegron FDA-approved for men on BPH therapy |
| Desmopressin | Storage & OAB | DDAVP, NOCDURNA | Nocturnal polyuria; sex-stratified dosing; hyponatremia monitoring |
| Alpha Blockers | Voiding & Outlet | Tamsulosin, silodosin, alfuzosin, doxazosin, terazosin | BPH/LUTS first-line; MET for distal stones; IFIS risk |
| 5α-Reductase Inhibitors | Voiding & Outlet | Finasteride (Proscar), dutasteride (Avodart) | BPH ≥30 mL; PSA halving; MTOPS combination with α-blocker |
| Alpha Agonists | Voiding & Outlet | Midodrine, pseudoephedrine, phenylephrine | Mild SUI (off-label); priapism self-detumescence; orthostatic hypotension |
| Cholinergic Agonists | Voiding & Outlet | Bethanechol | Underactive bladder / detrusor underactivity; largely legacy |
| Skeletal Muscle Relaxants | Voiding & Outlet | Cyclobenzaprine, baclofen, tizanidine, methocarbamol | Pelvic-floor hypertonicity; baclofen for detrusor-sphincter dyssynergia |
| Dantrolene | Voiding & Outlet | Dantrium | Refractory dyssynergia; hepatotoxicity limits use; historical |
| Oral IC/BPS Agents | Bladder Pain & IC/BPS | Pentosan polysulfate (Elmiron), amitriptyline, hydroxyzine, cimetidine | IC/BPS systemic therapy; PPS maculopathy requires annual screening |
| Intravesical Agents | Bladder Pain & IC/BPS | DMSO, heparin, lidocaine, bupivacaine, rescue cocktail (lido + heparin + bicarb) | IC/BPS flare therapy; GAG replenishment; rescue cocktail |
| Gabapentinoids | Neuropathic & Pelvic Pain | Gabapentin, pregabalin | Neuropathic pelvic pain, pudendal neuralgia, vulvodynia |
| Tricyclic Antidepressants | Neuropathic & Pelvic Pain | Amitriptyline, nortriptyline, imipramine | IC/BPS, CP/CPPS, neuropathic pain; amitriptyline workhorse |
| SNRIs | Neuropathic & Pelvic Pain | Duloxetine, venlafaxine, milnacipran | Neuropathic pelvic pain; duloxetine SUI-approved in Europe |
| NSAIDs & Analgesics | Neuropathic & Pelvic Pain | Ibuprofen, naproxen, celecoxib, acetaminophen, ketorolac | Acute pelvic pain, post-op analgesia; ERAS narcotic-sparing |
| Topical Compounded Agents | Neuropathic & Pelvic Pain | Compounded amitriptyline, baclofen, gabapentin, ketamine, lidocaine | Refractory vulvodynia, vestibulodynia; avoids systemic effects |
| Local Anesthetics | Neuropathic & Pelvic Pain | Lidocaine, bupivacaine, ropivacaine, mepivacaine | Pudendal blocks; intravesical; IPP and urethroplasty penile block |
| Antispasmodics | Neuropathic & Pelvic Pain | Diazepam (vaginal suppository), cyclobenzaprine, baclofen | Pelvic-floor spasticity; diazepam vaginal suppository is classic |
| Botulinum Toxin | Neuromodulation Adjuncts | OnabotulinumtoxinA (Botox) | Intradetrusor for OAB/NDO; external sphincter for DSD |
| Perioperative Antibiotic Prophylaxis | Infection & Prophylaxis | Cefazolin, vancomycin, gentamicin, ceftriaxone, piperacillin-tazobactam, fluconazole | AUA 2020 BPS framework; PUMP/Barham challenge IPP protocols |
| UTI Treatment Antibiotics | Infection & Prophylaxis | Nitrofurantoin, TMP-SMX, fosfomycin, fluoroquinolones, β-lactams, aminoglycosides | Uncomplicated vs complicated UTI; antibiogram-driven selection |
| UTI Suppressive & Prophylactic Therapy | Infection & Prophylaxis | Nitrofurantoin 50-100 mg qhs, low-dose TMP/SMX, cephalexin, post-coital regimens | Recurrent UTI prevention; 3–6 month courses; post-coital regimens |
| Non-Antibiotic UTI Prevention | Infection & Prophylaxis | Methenamine, D-mannose, vaginal estrogen, cranberry, probiotics | Methenamine + vaginal estrogen strongest; ALTAR trial |
| Antifungals | Infection & Prophylaxis | Fluconazole, amphotericin B, echinocandins | Prosthetic infection prevention (PUMP 92% reduction); candiduria |
| Prosthetic Infection & Biofilm Protocols | Infection & Prophylaxis | IPP dipping solutions (vanc-gent, Irrisept by device), salvage washout regimens | Device-specific dipping; 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 also BPH-approved; nitrate contraindication |
| Intracavernosal Injection Agents | Sexual Medicine & Andrology | Alprostadil (Caverject/Edex), bimix, trimix, quadmix | ED refractory to oral; ~80% success; trimix workhorse |
| Intraurethral Alprostadil | Sexual Medicine & Andrology | MUSE (Medicated Urethral System for Erection) | Needle-free ED option; 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 first-line for ED alone |
| Androgen Adjuncts | Sexual Medicine & Andrology | hCG, clomiphene, enclomiphene (Enclomid), anastrozole | Fertility-preserving TRT alternatives; maintain spermatogenesis |
| Peyronie's Disease Agents | Sexual Medicine & Andrology | Collagenase clostridium histolyticum (Xiaflex), interferon α-2b, verapamil | CCH only FDA-approved; IMPRESS ~8° net curvature reduction |
| Priapism Management | Sexual Medicine & Andrology | Intracavernosal phenylephrine, etilefrine, pseudoephedrine, daily low-dose PDE5i (SCD prevention) | Acute phenylephrine detumescence; daily PDE5i for SCD stuttering |
| Vaginal & Topical Estrogen | Hormonal Therapies | Estradiol cream/ring (Estring)/tablet (Vagifem), conjugated equine estrogen cream (Premarin) | GSM; rUTI prevention (AUA-endorsed); minimal systemic absorption |
| Vaginal DHEA | Hormonal Therapies | Prasterone (Intrarosa) 6.5 mg | GSM alternative for hormone-sensitive cancer history |
| Vaginal Moisturizers & Lubricants | Hormonal Therapies | Hyaluronic acid, polycarbophil, polyacrylic acid, water/silicone lubricants | Nonhormonal first-line GSM therapy; default for breast-cancer survivors |
| Ospemifene | Hormonal Therapies | Osphena 60 mg daily | SERM for GSM dyspareunia; oral 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 |
| Gender-Affirming Hormone Therapy | Hormonal Therapies | Estradiol, testosterone, progesterone, spironolactone, GnRH agonists | Perioperative GAS context; WPATH SOC8; hold estrogen peri-vaginoplasty |
| High-Potency Topical Corticosteroids | Dermatologic & Topical Urethral | Clobetasol 0.05%, betamethasone, mometasone | Lichen sclerosus first-line; reduces urethral stricture recurrence |
| Topical Calcineurin Inhibitors | Dermatologic & Topical Urethral | Tacrolimus 0.1% (Protopic), pimecrolimus (Elidel) | Steroid-sparing maintenance for LS / vulvar dermatoses |
| Intralesional Corticosteroids | Dermatologic & Topical Urethral | Triamcinolone acetonide | Hunner lesions, refractory LS, keloid, dilation-resistant stricture |
| Antimitotics & Antifibrotics | Dermatologic & Topical Urethral | Mitomycin C, triamcinolone | Urethral stricture prevention adjunct at incision / urethroplasty site |
| Drug-Coated Balloon Therapy | Dermatologic & Topical Urethral | Optilume (paclitaxel-coated balloon) | Anterior urethral stricture; ROBUST III FDA approval |
| Platelet-Rich Plasma | Dermatologic & Topical Urethral | Autologous PRP injection | Regenerative urology; vulvovaginal, Peyronie's, ED; evidence developing |
| Visualization Agents | Intraoperative Adjuncts | ICG, methylene blue, indigo carmine, sodium fluorescein, pudexacianinium (ASP-5354) | Perfusion, ureter ID, lymphatic mapping; ICG needs NIR |
| Hemostatic Agents | Intraoperative Adjuncts | Surgicel, Arista AH, Gelfoam/Surgiflo, FloSeal, topical thrombin (Evithrom/Recothrom) | Diffuse oozing; passive vs active; FloSeal for renal bed |
| Tissue Sealants | Intraoperative Adjuncts | Fibrin sealants (Tisseel/Evicel/Artiss), TachoSil, cyanoacrylates (Dermabond), PEG (CoSeal) | Anastomotic reinforcement; PICS for Peyronie's; skin closure |
| Hydrodissection | Intraoperative Adjuncts | Saline ± epinephrine, vasopressin, ornipressin, lidocaine + epinephrine | Vaginal-wall plane development + hemostasis (prolapse surgery, vaginal hysterectomy, colpocleisis) |
| Tranexamic Acid | Intraoperative Adjuncts | TXA — IV, oral, topical, irrigation | Antifibrinolytic; reduces bleeding across reconstructive surgery |
| Liposomal Bupivacaine | Intraoperative Adjuncts | Exparel (bupivacaine liposome injectable suspension) | Extended 72+ hr analgesia; IPP, urethroplasty, urogyn ERAS |
| VTE Prophylaxis | Perioperative & ERAS | Enoxaparin, unfractionated heparin, rivaroxaban, apixaban, SCDs | Postoperative thromboprophylaxis; AUA-stratified by procedure and patient |
| Anticoagulation Reversal | Perioperative & ERAS | Andexanet alfa, idarucizumab, 4-factor PCC, vitamin K, protamine | Emergent reversal for bleeding or urgent surgery; agent-specific |
| Bowel Preparation | Perioperative & ERAS | PEG (MoviPrep, GoLYTELY), sodium phosphate, oral antibiotics (neomycin + erythromycin/metronidazole) | Before urinary diversion / ileal conduit / augmentation |
| Post-op Bowel & Ileus Management | Perioperative & ERAS | Alvimopan (Entereg), simethicone, bisacodyl, docusate, metoclopramide, prokinetics | ERAS ileus prevention; alvimopan in urinary diversion |
| Corticosteroids | Perioperative & ERAS | Dexamethasone (PONV, airway, allergic), methylprednisolone (inflammation), prednisone (flares) | PONV prophylaxis, airway edema; single-dose intraop dex standard |
| Urinary Acidifiers | Urinary Diversion-Specific | Sodium bicarbonate (for acidosis), ammonium chloride, ascorbic acid | Acid-base management in ileal conduit / orthotopic neobladder |
| Vitamin B12 Supplementation | Urinary Diversion-Specific | Cyanocobalamin IM or oral, methylcobalamin | Post-ileal-resection deficiency; annual monitoring after diversion |
| Mucus Management | Urinary Diversion-Specific | N-acetylcysteine, saline irrigation, bicarbonate irrigation | Conduit / pouch mucus; prevents catheter obstruction |
| Parasympathomimetics | Legacy & Low-Evidence | Bethanechol, neostigmine, pyridostigmine | Underactive bladder; evidence weak; largely legacy |
| Imipramine | Legacy & Low-Evidence | Tofranil | Historical SUI and childhood enuresis; largely superseded |
| Phenazopyridine | Legacy & Low-Evidence | Pyridium, AZO | Symptomatic analgesic; 2-day max; G6PD hemolysis risk |
| Phytotherapy | Legacy & Low-Evidence | Saw palmetto (Serenoa repens), beta-sitosterol, pumpkin seed, Pygeum africanum | BPH symptom relief; Cochrane found no benefit over placebo |