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A complete guide to the investigation and management of patients with overactive bladder syndrome

Published:January 05, 2023DOI:https://doi.org/10.1016/j.ogrm.2022.11.002

      Abstract

      Overactive bladder (OAB) is defined by ICS as urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease. OAB is a symptom-based diagnosis with tools such as bladder diaries assisting in the diagnosis.
      Cystoscopy and urodynamic studies are not required prior to starting non-surgical treatment options (unless there are red flags). First line treatments are lifestyle modifications and bladder retraining. Anticholinergic drugs are the recommended first line medications, but clinicians must be mindful of the anticholinergic burden of a patients’ cumulative medications. Beta-adrenoceptor agonists should be used as second-line agents. For refractory OAB Botulinum toxin A can be used. Neuromodulation is an increasingly popular and available treatment option for patients with refractory OAB symptoms. More complex reconstructive surgery is reserved for the most resistant cases.

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      Further reading

        • Cardozo L.
        Systematic review of overactive bladder therapy in females.
        Can Urol Assoc J. 2011 Oct; 5 (PMID: 21989527; PMCID: PMC3193389): S139-S142https://doi.org/10.5489/cuaj.11185
      1. https://www.baus.org.uk/_userfiles/pages/files/Patientss/Leaflets/OAB%20options.pdf.

      2. https://www.nhs.uk/conditions/urinary-incontinence/treatment/.

        • Leron E.
        • Weintraub A.Y.
        • Mastrolia S.A.
        • Schwarzman P.
        Overactive bladder syndrome: evaluation and management.
        Curr Urol. 2018 Mar; 11 (Epub 2018 Feb 20. PMID: 29692690; PMCID: PMC5903463): 117-125https://doi.org/10.1159/000447205
        • National Institute for Health and Care Excellence
        Urinary Incontinence in patients: management.
        NICE Guideline, 2013 (CG 171)
      3. Urinary Incontinence – BMJ masterclasses primary care general update.