Management of refractory overactive bladder
Giarenis I, Cardozo L.Minerva Ginecol. 2013 Feb;65(1):41-52.


Department of Urogynecology, King's College Hospital NHS Foundation Trust, London, UK -


Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. It is a common, under-diagnosed and therefore under-treated condition which can have a detrimental effect on physical functioning and psychological well-being. Initial treatment of OAB includes lifestyle advice, behavioural modifications, bladder retraining and pelvic floor muscle training, usually in combination with antimuscarinic agents. However, approximately 40% either do not achieve an acceptable level of therapeutic benefit or remain completely refractory to treatment. Our review will focus on the management of this challenging group of women with refractory OAB. For those women with persistent symptoms following conservative therapy, a thorough clinical assessment and appropriate investigations are required. Treatment of any underlying pathology should be considered. The introduction of bladder selective antimuscarinic agents, extended release formulations, alternative routes of administration or use of other drugs could be explored. Modalities such as intravesicalBotulinum toxin, neuromodulation (peripheral or sacral) may be offered. Finally, when all other options have been explored and proven unsuccessful, inappropriate or not feasible, reconstructive surgery or catheter insertion (suprapubic or transurethral) can be considered as a last resort.