Fast Five Quiz: Overactive Bladder

Bradley Schwartz, DO


September 25, 2020

The AUA/SUFU guidelines include these key recommendations for the treatment of OAB:

  • First-line treatment for all patients with OAB are behavioral therapies (eg, bladder training, bladder control strategies, pelvic floor muscle training, fluid management).

  • Behavioral therapies may be combined with pharmacologic management.

  • Oral antimuscarinic agents or oral beta-3 adrenoceptor agonists should be offered as second-line therapy. If an IR and an ER formulation are available, then ER formulations should preferentially be prescribed over IR formulations because of lower rates of dry mouth.

  • Transdermal oxybutynin (patch or gel) may be offered as second-line therapy.

  • If a patient experiences inadequate symptom control and/or unacceptable adverse drug events with one antimuscarinic medication, then a dose modification or a different antimuscarinic medication or a beta-3 adrenoceptor agonist may be tried.

  • Combination therapy with an antimuscarinic agent and a beta-3 adrenoceptor agonist for OAB refractory to monotherapy with either antimuscarinic agents or beta-3 adrenoceptor agonists can be considered.

  • Antimuscarinic agents should not be given to patients with narrow-angle glaucoma unless approved by the treating ophthalmologist, and they should be used with extreme caution in patients with impaired gastric emptying or a history of urinary retention.

  • Before abandoning effective therapy with antimuscarinic agents because of constipation and dry mouth, these adverse effects should be addressed with bowel management, fluid management, dose modification, or alternative antimuscarinic agents.

  • Caution is needed when prescribing antimuscarinic agents in patients who are using other medications with anticholinergic properties.

  • Intradetrusor onabotulinumtoxin A at a 100 U dose is a third-line treatment in carefully selected patients with OAB who have received thorough counseling and whose OAB has proved refractory to first- and second-line OAB treatments. These patients must be able and willing to return for frequent postvoid residual evaluation and able and willing to perform self-catheterization if necessary.

  • Clinicians may offer peripheral tibial nerve stimulation as third-line treatment in carefully selected patients.

  • Clinicians may offer sacral neuromodulation as third-line treatment in a carefully selected patient population characterized by severe refractory OAB symptoms or those who are not candidates for second-line therapy and are willing to undergo a surgical procedure.

  • In rare cases, augmentation cystoplasty or urinary diversion for severe, refractory, complicated OAB may be considered.

Read more about the treatment of OAB.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Overactive Bladder.

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