Current Bladder Dysfunction Reports

, Volume 13, Issue 4, pp 301–308 | Cite as

Salvage Combination Therapies for Refractory Overactive Bladder

  • Sarah Martin
  • Esther Han
  • Jason GilleranEmail author
Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Reconstructed Bladder Function & Dysfunction


Purpose of Review

With a high prevalence of overactive bladder (OAB) worldwide and rising health care costs for patients who fail first-, second-, and third-line treatments, there is a growing need to explore novel strategies to address the most refractory cases of OAB. The concept of utilizing combination treatment regimens to maximize efficacy while minimizing morbidity and side effects, in a cost-effective manner, is discussed in this review article.

Recent Findings

A literature review over the last 10 years was performed, focusing on therapies used in combination for OAB including behavioral therapy, pharmacologic therapy, neuromodulation, and botulinum toxin. A separate literature review specifically for augmentation cystoplasty was also undertaken. Such “salvage” treatments suggested in the literature include pharmacologic therapy in combination or with behavioral modification, various forms of neuromodulation with medication, alternative forms of neuromodulation, with or without prior botulinum toxin injections, and lastly, augmentation cystoplasty.


In this review article, we outline combination therapies such as adding mirabegron to solifenacin, anticholinergic medication in addition to either behavioral therapy or various types of neuromodulation and using neuromodulation after failed botulinum toxin injections are efficacious treatment approaches and have shown to be superior to monotherapy for the treatment non-neurogenic refractory OAB. In the most severe cases of refractory OAB, augmentation cystoplasty remains an option that provides acceptable results in the appropriately selected patient.


Overactive bladder Anticholinergics Mirabegron Salvage therapy Neuromodulation Augmentation cystoplasty 


Compliance with Ethical Standards

Conflict of Interest

Sarah Martin declares that she has no conflict of interest.

Esther Han declares that she has no conflict of interest.

Jason Gilleran declares that he has 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

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Copyright information

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

Authors and Affiliations

  1. 1.Department of Urology DetroitDetroit Medical CenterDetroitUSA
  2. 2.Department of Urology Royal OakWilliam Beaumont HospitalRoyal OakUSA

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