In the last decades, a number of new antimuscarinic drugs have been introduced for treatment of the overactive bladder (OAB), defined symptomatically (OAB syndrome) or urodynamically (detrusor overactivity). Recently, three new drug principles have been approved for clinical use, the b 3 -adrenoceptor agonist, mirabegron, the phosphodiesterase-5 inhibitor, tadalafil and the blocker of afferent and efferent nerves, botulinum toxin. However, new alternatives are continuously being explored. OAB is a filling disorder, and ATP is involved in the generation of afferent impulses. One way of blocking the ATP afferent pathway is through the use of P2X3 receptor antagonists. In animal models, this strategy appears to work very well, but whether it translates effectively to man remains to be established. Evidence suggests that components of the endocannabinoid system are involved in regulation of bladder function. Clinical studies of cannabinoid extracts on LUTS are scarce and essentially restricted to patients with MS, and the results have so far not been convincing. Amplification of endocannabinoid activity by inhibiting their degradation via fatty acid amide hydrolase inhibitors may be an attractive approach, but no clinical experiences in OAB have been reported. Studies of the lower urinary tract have indicated that several transient receptor potential (TRP) channels, including TRPV1, TRPV2, TRPV4, TRPM8 and TRPA1, are expressed in the bladder and may act as sensors of stretch and/or chemical irritation. Animal studies have shown that inhibition of these pathways can be effective for the reduction in bladder activity. However, the roles of these channels for normal function and in pathological states have not been established, and so far adverse effects (hyperthermia) have hampered development of antagonists.Lower urinary tract symptoms (LUTS) are generally divided into storage (irritative), voiding (obstructive) and post-micturition components [1]. Particularly, the storage disorder, overactive bladder (OAB), defined symptomatically as the OAB syndrome, or urodynamically as detrusor overactivity (DO), can have major effects on quality of life and social functioning. In addition to antimuscarinic drugs, which still constitute first-line pharmacological treatment of the LUTS/OAB, three new drug principles have recently been approved for clinical use, the b 3 -adrenoceptor agonist, mirabegron, the phosphodiesterase-5 inhibitor tadalafil and the blocker of afferent and efferent nerves, botulinum toxin, whose places in therapy still have to be established [2][3][4][5]. These drugs have good initial response rates, but are not effective in all patients, and alternatives are continuously being explored. There are many agents with theoretically interesting profiles that have been or still are considered as promising, but currently do not seem to be in active development (table 1). For example, nerve growth factor (NGF) and other neurotrophins have been suggested to be an interesting target for treatment and a bioma...