Position statement: a clinical approach to the management of adult non‐neurogenic overactive bladder

Abstract

Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or β3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management.

Overactive bladder in patients with myasthenia gravis—A cross‐sectional population‐based study

“…For all MG patients, both male 15 and female, 13 conservative treatment such as pelvic floor training and weight loss should be recommended. If symptoms remain, medical treatment should be considered, including beta‐3‐adrenergic agonists 16,17 . In clinical practice, these options are important to consider, particularly if a higher dose of pyridostigmine is needed, especially in patients with a high OAB bother score, where the pyridostigmine dose needs to be increased above 300 mg per day.…”

Position statement: a clinical approach to the management of adult non‐neurogenic overactive bladder

“…We believe that we have provided a fair and balanced view on our position statement 1 regarding the management of OAB. Understanding the complex interplay of various pathophysiological factors that contribute to OAB (including nocturia) is important for clinicians to make an informed decision about the most suitable treatment options for their patients based on their needs and circumstances.…”

“…I thank Martin and colleagues for the letter on our article 1 . While the International Continence Society defines overactive bladder (OAB) as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of a urinary tract infection or other obvious pathology; 2 it is generally agreed upon that nocturia is more than just a problem relating to bladder storage and can often be multifactorial in nature 3 .…”

Efficacy of percutaneous and transcutaneous posterior tibial nerve stimulation on idiopathic overactive bladder and interstitial cystitis/painful bladder syndrome: A systematic review and meta‐analysis

“…Since that some patients do not respond to these lines properly, and also because frustrating adverse effects of the mentioned drugs often lead to a drop in patient adherence rates, 16 the demand for a safe and effective third-line treatment emerges. These new methods include botulinum neurotoxins, sacral neuro-stimulation, and percutaneous and transcutaneous posterior tibial nerve stimulation (P-PTNS and T-PTNS) 17 that in this study, our focus will be on the last two, and will be referred to as PTNS and TTNS for ease. PTNS was initially introduced by Stoller in 1999, and later on, in 2000, received food and drug administration (FDA) approval for office-based OAB treatment, and in 2006, received The National Institute for Health and Care Excellence (NICE) approval.…”