Current Bladder Dysfunction Reports

, Volume 13, Issue 3, pp 158–161 | Cite as

Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)?

  • Marc P. Schneider
  • Andrea Tubaro
  • Fiona C. BurkhardEmail author
Overactive Bladder and Lower Urinary Tract Symptoms (U Lee and S Adelstein, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Overactive Bladder and Lower Urinary Tract Symptoms


Purpose of Review

Overactive bladder (OAB) is highly prevalent with increasing age. Conservative management including lifestyle adaptation, controlled fluid intake, and bladder training are considered first-line therapeutic options. Second-line options are medication such as antimuscarinics or beta-3 adrenergic receptor agonists. Therapy refractory patients should be referred to a specialist for further evaluation.

Recent Findings

It currently remains unclear if patients should undergo routine urodynamic investigation (UDI) before offering third-line therapies like sacral neuromodulation (SNM) or intradetrusor injection of onabotulinumtoxinA (IdetInBotA). The aim of this narrative review was to assess if the presence of detrusor overactivity (DO) can predict treatment success of third-line therapies for OAB.


There is only limited evidence available for both IdetInBotA and SNM, but treatment success does not appear to be related to the presence of DO in baseline UDI. Hence, routine UDI is not mandatory in patients with OAB but remains an option when its outcome is likely to change the treatment strategy or to assess the risk of upper urinary tract deterioration.


Detrusor overactivity Overactive bladder Neuromodulation therapy Sacral neuromodulation Intradetrusor injection of onabotulinumtoxinA 


Compliance with Ethical Standards

Conflict of Interest

Marc P. Schneider, Andrea Tubaro, and Fiona C. Burkhard declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.CrossRefPubMedGoogle Scholar
  2. 2.
    Drake MJ. Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013. Neurourol Urodyn. 2014;33(5):622–4. Scholar
  3. 3.
    Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36. PubMedCrossRefGoogle Scholar
  4. 4.
    •• Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2018; The current European reference for diagnosing and managing urinary incontinence.
  5. 5.
    Rovner ES, Goudelocke CM. Urodynamics in the evaluation of overactive bladder. Curr Urol Rep. 2010;11(5):343–7. Scholar
  6. 6.
    Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62(5 Suppl 2):28–37. discussion 40-2CrossRefPubMedGoogle Scholar
  7. 7.
    •• Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol. 2016;69(2):324–33. The current European reference for diagnosing and managing lower urinary tract symptoms and dysfunction in patients with neurogenic disorders.CrossRefPubMedGoogle Scholar
  8. 8.
    Digesu GA, Khullar V, Cardozo L, Salvatore S. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn. 2003;22(2):105–8. Scholar
  9. 9.
    Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175(1):191–4; discussion 4-5. Scholar
  10. 10.
    Lowenstein L, Pham T, Abbasy S, Kenton K, Brubaker L, Mueller ER, et al. Observations relating to urinary sensation during detrusor overactivity. Neurourol Urodyn. 2009;28(6):497–500. Scholar
  11. 11.
    Guralnick ML, Grimsby G, Liss M, Szabo A, O'Connor RC. Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity. Int Urogynecol J. 2010;21(3):325–9. Scholar
  12. 12.
    Hanna-Mitchell AT, Kashyap M, Chan WV, Andersson KE, Tannenbaum C. Pathophysiology of idiopathic overactive bladder and the success of treatment: a systematic review from ICI-RS 2013. Neurourol Urodyn. 2014;33(5):611–7. Scholar
  13. 13.
    Nitti VW, Rovner ES, Bavendam T. Response to fesoterodine in patients with an overactive bladder and urgency urinary incontinence is independent of the urodynamic finding of detrusor overactivity. BJU Int. 2010;105(9):1268–75. Scholar
  14. 14.
    Malone-Lee JG, Al-Buheissi S. Does urodynamic verification of overactive bladder determine treatment success? Results from a randomized placebo-controlled study. BJU Int. 2009;103(7):931–7. Scholar
  15. 15.
    Rovner E, Kennelly M, Schulte-Baukloh H, Zhou J, Haag-Molkenteller C, Dasgupta P. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Neurourol Urodyn. 2011;30(4):556–62. Scholar
  16. 16.
    • Richter HE, Amundsen CL, Erickson SW, Jelovsek JE, Komesu Y, Chermansky C, et al. Characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation for refractory urgency urinary incontinence. J Urol. 2017;198(4):890–6. An interesting analysis of prognostic factors for clinical response to onabotulinumtoxinA and sacral neuromodulation for refractory UUI.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    South MM, Romero AA, Jamison MG, Webster GD, Amundsen CL. Detrusor overactivity does not predict outcome of sacral neuromodulation test stimulation. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(12):1395–8. CrossRefPubMedGoogle Scholar
  18. 18.
    Groenendijk PM, Lycklama a Nyeholt AA, Heesakkers JP, van Kerrebroeck PE, Hassouna MM, Gajewski JB, et al. Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence. BJU Int. 2008;101(3):325–9. Scholar
  19. 19.
    Brading AF. A myogenic basis for the overactive bladder. Urology. 1997;50(6A Suppl):57–67. discussion 8-73CrossRefPubMedGoogle Scholar
  20. 20.
    Vereecken RL, Das J. Urethral instability: related to stress and/or urge incontinence? J Urol. 1985;134(4):698–701.CrossRefPubMedGoogle Scholar
  21. 21.
    Dokmeci F, Cetinkaya SE, Seval MM, Dai O. Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle. Eur J Obstet Gynecol Reprod Biol. 2017;212:126–31. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marc P. Schneider
    • 1
  • Andrea Tubaro
    • 2
  • Fiona C. Burkhard
    • 1
  1. 1.Department of Urology, InselspitalUniversity of BernBernSwitzerland
  2. 2.Department of Urology, Sant’Andrea HospitalSapienza University of RomeRomeItaly

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