Fast Five Quiz: Overactive Bladder Pharmacologic Management

Bradley Schwartz, DO


February 26, 2021

Figure 1. Overactive bladder. Coronal section through female bladder. Fat and peritoneum removed to show pelvic floor and pelvic splanchnic nerves.

Anticholinergic agents are currently the first-line pharmacologic therapy for OAB. These agents are thought to act primarily by inhibiting involuntary detrusor muscle contractions (at the level of the efferent pathway), but identification of muscarinic receptors in the urothelium/suburothelium suggests that they may also affect the afferent sensory pathway. The goals of therapy with anticholinergic agents are to prevent inappropriate detrusor contractions and maintain normal bladder function while minimizing adverse effects.

According to the 2019 guidelines from the American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), clinicians should offer oral antimuscarinics (anticholinergics) or oral beta-3 adrenoceptor agonists after first offering behavioral therapy.

Although tricyclic antidepressants have been used to treat OAB, they are not recognized as first-line therapy for the treatment of OAB.

Detrusor injections of onabotulinumtoxinA are approved by the US Food and Drug Administration (FDA) for the treatment of adults with OAB who cannot use, or do not adequately respond to, anticholinergic medication.

Learn more about anticholinergic agents in the management of OAB.


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